Neonatal jaundice

A condition which is common 2-5 days after birth.

Etiology:

Bilirubin is a yellow pigment that is created in the body during the normal recycling of old red blood cells. Bilirubin is released due to the breakdown of heme in red blood cells. The liver takes up the byproducts of this break down and excretes them as bile, they are then removed from the body in the stool. If this old red blood cell breakdown occurs more quickly than the excretion of the byproducts the byproducts build up in tissues. This build up of the yellow bilirubin pigment in the tissues is called jaundice.

Neonatal jaundice is the results of abnormally high bilirubin levels, > 85 umol/l (5 mg/dL) manifests clinical jaundice in neonates.

Symptoms:

  • The excess bilirubin pigments build up in the tissues manifesting as yellow tinged skin and sclera of the eye.
  • jaundice typically first appears in the face then progresses caudally to trunk and extremities.

Conditions that increase the number of red blood cells that need to be broken down, and can cause more severe newborn jaundice:

  • Abnormal blood cell shapes
  • Blood type mismatch between the mother and the baby
  • Bleeding underneath the scalp (cephalohematoma) caused by a difficult delivery
  • Higher levels of red blood cells, which is more common in small-for-gestational-age babies and some twins
  • Infection
  • Lack (deficiency) of certain important enzymes

Conditions that make it harder for the baby’s body to remove bilirubin may also lead to more severe jaundice:

  • Certain medications
  • Congenital infections, such as rubella, syphilis, and others
  • Diseases that affect the liver or biliary tract, such as cystic fibrosis or hepatitis
  • Hypoxia
  • Infections (such as sepsis)
  • Many different genetic or inherited disorders
Assessment:
  • every 8-12hrs
  • perform assessment in well lit room
  • blanch skin with digit pressure to reveal underlying tissue colour
  • TSB levels should be performed on every janundiced infant within the first 24hrs after birth
  • take Total Serum Bilirubin (TSB) levels to ensure levels remain <15mg/dL

Treatment:

  1. Phototherapy: will be used if the bilirubin level is too high or is rising quickly. Blue light phototherapy acts to break down bilirubin in the skin. Phototherapy is initiated if TSB >25mg/dL.
  2. Blood transfusion: Used in the treatment of the most severe cases of jaundice. An exchange blood transfusion will be used.
  3. Intravenous immunoglobulin: another very effective method of reducing bilirubin levels.  Gamma globulins is used to treat cases of isoimmune hemolytic disease (due to fetal-maternal blood type incompatibility and ABO and Rh hemolytic disease of the newborn).
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: