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Neonatal Jaundice By Dr. Nahed Al-Nagger

Neonatal Jaundice By Dr. Nahed Al-Nagger. Neonatal Jaundice. Learning Objectives: Define hyperbilirubinemia. Differentiate between physiological and pathological jaundice. State causes of hyperbilirubinemia. Discuss the pathophysiology of hyperbilirubinemia.

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Neonatal Jaundice By Dr. Nahed Al-Nagger

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  1. Neonatal JaundiceBy 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.

  4. Neonatal Jaundice • Visible form of bilirubinemia • Newborn skin >5 mg / dl • Occurs in 60% of term and 80% of preterm neonates • However, significant jaundice occurs in 6 % of term babies

  5. Bilirubin metabolism Hb → globin + haem 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

  6. Bilirubin Production & Metabolism

  7. Clinical assessment of jaundice Area of body Bilirubin levels mg/dl(*17=umol) Face 4-8 Upper trunk 5-12 Lower trunk & thighs 8-16 Arms and lower legs 11-18 Palms & soles > 15

  8. 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.

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

  10. 15 10 5 Bilirubin level mg/dl Term Preterm 1 2 3 4 5 6 10 11 12 13 14 Age in Days Course of physiological jaundice

  11. 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

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

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

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

  15. Risk factors for jaundice 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

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

  17. 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.

  18. Babies under phototherapy Baby under conventional phototherapy Baby under triple unit intense phototherapy

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

  20. 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

  21. 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

  22. 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.

  23. 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).

  24. QUESTIONS?

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