1. Bronze baby syndrome

2. INTRODUCTION Bronze Baby Syndrome Intense grey-brown discoloration of the skin, serum, and urine, especially in premature infants; when phototherapy was used to reduce hyper- bilirubinemia. Pre- existing hepatic disease is suspected as a cause of the jaundice and may have prevented the biliary excretion of the photo oxidation products of bilirubin; their retention resulted in the bronze discoloration

3. DEFINITION Bronze baby syndrome is the dark grey- brown pigmentation of skin, mucous membrane, and urine following phototherapy. Hepatic dysfunction has to be there for this condition to be present. We report a neonate with dark brown pigmentation of the skin

4. CASUS & RISK FACTORS  The exact cause of the gray -brown discoloration in bronze baby syndrome is uncertain  Premature infants  Premature infants  undernourished or underweight  Reduced liver (hepatic) function  Reduced kidney (renal) function  High dose of chloramphenicol

5. Pathogenesis Proposed mechanisms including photodestruction of porphyrin and deposition in the skin or a deposition of a photo-isomer of bilirubin the skin Proposed mechanisms including photodestruction of porphyrin and deposition in the skin or a deposition of a photo-isomer of bilirubin the skin

6. Clinical manifestation Dark gray - brown discoloration of the entire skin surface, fading approximately 6 weeks after stopping phototherapy Dark gray - brown discoloration of the entire skin surface, fading approximately 6 weeks after stopping phototherapy Fussiness Fussiness Poor feeding Poor feeding Weakness Weakness Vomiting Vomiting Changes in mental status such as lethargy and less alertness (obtundation) Changes in mental status such as lethargy and less alertness (obtundation) Pale appearance (pallor) Pale appearance (pallor)

7. CONTI… Ashen-gray colour of the skin Ashen-gray colour of the skin Abdominal tenderness Abdominal tenderness Abdominal distention Abdominal distention Hypotension (low blood pressure) Hypotension (low blood pressure) Cyanosis causing blue lips, blue nails and bluish skin Cyanosis causing blue lips, blue nails and bluish skin Respiratory distress Respiratory distress Low body temperature Low body temperature

8. DIAGNOSTIC EVALUATION o Blood tests. o CT scan, o abdominal X-rays, or abdominal ultrasound o abdominal X-rays, or abdominal ultrasound o Electrocardiography (ECG) and echocardiography o Electrocardiography (ECG) and echocardiography

9. MANAGEMENT

10. MEDICAL MANAGEMENT  PHARMACOLOGICAL MANAGEMENT  antibiotic  chloramphenicol  cephalosporin and phenobarbital

11. CONTI…  NON PHARMACOLOGICAL MANAGEMENT Exchange Transfusion: Here, a major part of your baby’s blood will be removed and replaced with fresh blood group matched blood or plasma using a catheter. Exchange Transfusion: Here, a major part of your baby’s blood will be removed and replaced with fresh blood group matched blood or plasma using a catheter. Haemodialysis: With this, the toxins are removed from your baby’s bloodstream and a balance is achieved in potassium and sodium levels to stabilise the baby’s blood pressure Haemodialysis: With this, the toxins are removed from your baby’s bloodstream and a balance is achieved in potassium and sodium levels to stabilise the baby’s blood pressure Oxygen therapy Oxygen therapy

12. PREVENTION  Ante-natal screening to detect Rh iso -immunization & prompt administration of Anti D after first obstetric event.  Ensure adequate breast feeding.  Educate parent about danger signs to ensure immediate checkup.  Follow-up high risk babies( large cephalohematoma, family history of jaundice) for 2-3 days of discharge

13. FOLLOWUP o Babies with serum bilirubin>20 mg/dl & those who required ET should be kept under follow-up in high-risk clinic for neurodevelopmental outcome. o Hearing assessment should be done at 3months of age.

14. CONCLUSION Bronze baby syndrome (BBS) is an extremely rare dyschromia occurring in neonates with a raised conjugated bilirubin level under phototherapy …