Neonatal Jaundice

Neonatal Jaundice is common and is usually a benign condition in the newborn affecting 50% of term infants and 80% of preterm infants in first week of life.

The yellow colour usually results from the accumulation of unconjugated, nonpolar, lipid soluble bilirubin pigment in the skin. Jaundice usually becomes apparent in a head to toe progression, starting on the face and progressing to the abdomen and then the feet, as jaundice levels increase.

The physiological jaundice in term infants becomes visible on the 2nd or 3rd day, usually peaking between the 2nd and 4th days and decreasing between the 5th and 7th days after birth. In premature infant visible on day 3-4, peaks on day 6-8 and starts disappearing by day 7-9.

The factors related to higher susceptibility for physiological jaundice are high haemoglobin concentration, immaturity of liver uptake, abnormal mechanism of bilirubin breakdown, shorter life span of RBC.

Hyperbilirubinemia- can be caused by certain pathologic conditions or by exaggeration of the mechanisms responsible for neonatal jaundice.

Risk Factors for Hyperbilirubinemia

  • History of previous sibling needing phototherapy.
  • Jaundice observed in the 1st 24 hr.
  • Blood group incompatibility(ABO ,Rh Incompatibility) with positive direct Coombs test or other known haemolytic disease (G6PD deficiency).
  • Cephalohematoma or significant bruising.
  • Infant of diabetic mother.
  • Exclusive breastfeeding, particularly if weight loss is excessive.

The jaundice presents with in 1st 24 hours after birth is a medical emergency.

Clinical Assessment & Investigations for the Jaundiced Infant

  • Jaundice can be readily detected in the newborn by skin assessment depending whether it is just over the face, also over the chest and abdomen or upto the legs.
  • The need for investigation and intervention depends on the clinical estimate and the age of the child in hours.
  • Transcutaneous Bilirubin Measurement may be sometimes done. However, the trans-cutaneous bilirubin is unreliable following the commencement of phototherapy.
  • A serum bilirubin level is the deciding test if therapy is needed. Always, the cause should be investigated as well.
  • High risk infants should be monitored 4-6 hourly initially.

Clinical Management of Jaundice (Hyperbilirubinaemia)

  • Management is aimed at risk assessment, recognition and appropriate treatment of hyperbilirubinemia to prevent the development of severe hyperbilirubinemia and the possibility of bilirubin encephalopathy.
  • Plot the level on phototherapy graph according to Gestational age, Postnatal age in hours to determine the need for phototherapy.
  • If necessary, exchange blood transfusion may be done.
  • Hearing test should be done for all babies needing phototherapy.
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