Presentation is loading. Please wait.

Presentation is loading. Please wait.

Neonatal Jaundice By Dr. Nahed Al-Nagger

Similar presentations

Presentation on theme: "Neonatal Jaundice By Dr. Nahed Al-Nagger"— Presentation transcript:

1 Neonatal Jaundice By Dr. Nahed Al-Nagger

2 Neonatal Jaundice Learning Objectives: Define hyperbilirubinemia.
Differentiate between physiological and pathological jaundice. State causes of hyperbilirubinemia. Discuss the pathophysiology of hyperbilirubinemia. Describe the most dangerous complication of hyperbilirubinemia. List the three elements of therapeutic management. Design plan of care for baby has hyperbilirubinemia.

3 Neonatal Jaundice (Hyperbilirubinemia)
Definition: Hyperbilirubinemia refers to an excessive level of accumulated bilirubin in the blood and is characterized by jaundice, a yellowish discoloration of the skin, sclerae, mucous membranes and nails. Unconjugated bilirubin = Indirect bilirubin. Conjugated bilirubin = Direct bilirubin.


5 Neonatal Jaundice Newborn skin >5 mg / dl
Visible form of bilirubinemia Newborn skin >5 mg / dl Occurs in 60% of term and 80% of preterm neonates However, significant jaundice occurs in % of term babies

6 Bilirubin metabolism Non – heme source Hb → globin + haem 1 mg / kg
1g Hb = 34mg bilirubin Non – heme source 1 mg / kg Bilirubin Ligandin (Y - acceptor) Intestine Bilirubin glucuronidase Bil glucuronide Bil glucuronide β glucuronidase bacteria Bilirubin Stercobilin Bilirubin metabolism

7 Bilirubin Production & Metabolism

8 Clinical assessment of jaundice
Area of body Bilirubin levels mg/dl (*17=umol) Face Upper trunk Lower trunk & thighs Arms and lower legs Palms & soles > 15

9 Physiological jaundice
Characteristics Appears after 24 hours Maximum intensity by 4th-5th day in term & 7th day in preterm Serum level less than 15 mg / dl Clinically not detectable after 14 days Disappears without any treatment Note: Baby should, however, be watched for worsening jaundice.

10 Why does physiological jaundice develop?
Increased bilirubin load. Defective uptake from plasma. Defective conjugation. Decreased excretion. Increased entero-hepatic circulation.

11 Course of physiological jaundice
Age in Days Term Preterm 15 10 5 Bilirubin level mg/dl

12 Pathological jaundice
Appears within 24 hours of age Increase of bilirubin > 5 mg / dl / day Serum bilirubin > 15 mg / dl Jaundice persisting after 14 days Stool clay / white colored and urine staining clothes yellow Direct bilirubin> 2 mg / dl

13 Causes of jaundice Appearing within 24 hours of age
Hemolytic disease of NB : Rh, ABO Infections: TORCH, malaria, bacterial G6PD deficiency

14 Causes of jaundice Appearing between 24-72 hours of life Physiological
Sepsis Polycythemia Intraventricular hemorrhage Increased entero-hepatic circulation

15 Causes of jaundice After 72 hours of age Sepsis Cephalhaematoma
Neonatal hepatitis Extra-hepatic biliary atresia Breast milk jaundice Metabolic disorders (G6PD).

16 Risk factors for jaundice
J - jaundice within first 24 hrs of life A - a sibling who was jaundiced as neonate U - unrecognized hemolysis N – non-optimal sucking/nursing D - deficiency of G6PD I - infection C – cephalhematoma /bruising E - East Asian/North Indian

17 Diagnostic evaluation:
Normal values of unconjugated B. are 0.2 to 1.4 mg/dL. Investigate the cause of jaundice.

18 Therapeutic Management
Purposes: reduce level of serum bilirubin and prevent bilirubin toxicity Prevention of hyperbilirubinemia: early feeds, adequate hydration Reduction of bilirubin levels: phototherapy, exchange transfusion, Drugs Use of Phenobarbital promote liver enzymes and protein synthesis.

19 Babies under phototherapy
Baby under conventional phototherapy Baby under triple unit intense phototherapy

20 Phototherapy if hemolysis
Maisel’s chart Sr Bilirubin (mg/dl) Birth weight Age in hrs < 24 24 – 48 49 – 72 >72 <5 All 5-9 Phototherapy if hemolysis 10-14 < 2500g PHOTOTHERAPY > 2500g Investigate if bilirubin > 12mg% 15-19 EXCHANGE Consider Exchange Phototherapy > 20

21 Prognosis Early recognition and treatment of hyperbilirubinemia prevents severe brain damage.

22 Nursing considerations of Hyperbilirubinemia
Assessment: observing for evidence of jaundice at regular intervals. Jaundice is common in the first week of life and may be missed in dark skinned babies Blanching the tip of the nose

23 Approach to jaundiced baby
Ascertain birth weight, gestation and postnatal age Ask when jaundice was first noticed Assess clinical condition (well or ill) Decide whether jaundice is physiological or pathological Look for evidence of kernicterus* in deeply jaundiced NB *Lethargy and poor feeding, poor or absent Moro's, or convulsions

24 Nursing diagnosis See the high risk infant plan of care. Plus:
Body T., risk for imbalanced T. related to use of phototherapy. Fluid volume, risk for deficient related to phototherapy. Interrupted family process related to situational crisis, re hospitalization for the therapy.

25 The goals of planning Infant will receive appropriate therapy if needed to reduce serum bilirubin levels. Infant will experience no complications from therapy. Family will receive emotional support. Family will be prepared for home phototherapy (if prescribed).


Download ppt "Neonatal Jaundice By Dr. Nahed Al-Nagger"

Similar presentations

Ads by Google