Neonatal Jaundice
SGD
Dr Saffiullah
AP Paeds
By the end of this discussion you should be able to;
1.Make a differential diagnosis of common and
significant causes of jaundice in neonates
2.Differentiate between physiological and pathological
jaundice including persistent jaundice in neonates
3.Organise investigations for neonates presenting with
jaundice
4.Management of common and significant causes of
neonatal jaundice
5.Indications and side effects of different treatment
modalities of neonatal jaundice including
phototherapy

Learning outcomes
◦ Clinical jaundice appears at 2-3 days.
◦ Total bilirubin rises by less than 5 mg/dl per
day.
◦ Peak bilirubin occurs at 3-5 days of age.
 Peak bilirubin concentration in Full-term infant
<12mg/dl
 Peak bilirubin concentration in Premature infant
<15mg/dl
Physiologic jaundice
◦ Clinical jaundice is not resolved in 2 weeks in
the term infant and in 4 weeks in the Preterm
infant.
◦ Clinical jaundice appears again after it has
been resolved.
◦ Direct(conjugated) bilirubin concentration is
more than 1.5 mg/dl .
Pathologic jaundice
A 10 hours old baby boy born at term
developed jaundice?
1.What 6 relevant things would you ask in
the history?
2.What 6 relevant things would you look for
in examination?
1.What 6 investigations you would order?
2.How would you plan the treatment?
3.What 2 treatment modalities would you
consider?

Case 1
SBR 20 mainly indirect
 Hb 10, wbc 8000 and platelets 300000
 Mothers blood group O Rh positive, Baby’s
A Rh positive
 Coombs test positive

Case 2
SBR 20 mainly indirect
 Hb 10, wbc 8000 and platelets 300000
 Mothers blood group B Rh negative,
Baby’s A Rh positive
 Coombs test positive

Case 3





SBR 20 mainly indirect
Hb 10, wbc 8000 and platelets 300000
Mothers blood group A Rh positive, Baby’s
A Rh positive
Coombs test negative
Blood film showed spherocytes
Case 4





SBR 20 mainly indirect
Hb 10, wbc 20000 and platelets 300000
Mothers blood group A Rh positive, Baby’s
A Rh positive
C reative protein CRP 150
Coombs test negative
Case 5





SBR 20 mainly indirect
Hb 10, wbc 8000 and platelets 300000
Mothers blood group A Rh positive, Baby’s
A Rh positive
Coombs test negative
G6PD low
Case 6
Multiple
Single
550
Total serum bilirubin (micromol/litre)
500
Exchange transfusion
450
400
Phototherapy
350
300
250
200
150
100
50
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Days from birth






Increased water loss
Diarrhea
Retinal damage
Bronze baby, tanning
Mutations in DNA?  shield scrotum
Disturb of mother-infant interaction
Side effects of phototherapy
4 weeks old baby girl presented with
jaundice which started in the first couple
of days.On examination she was jaundice
and has hepatomegaly.
1.What 6 important questions would you
ask from her mother to help you with
diagnosis?
2.What 4 investigations would you do?

Case 6






SBR 20 ,19 direct, 1 indirect
Hb 15, wbc 8000 and platelets 300000
Mothers blood group O Rh positive, Baby’s
O Rh positive
Coombs test negative
Ultrasound abdomen hepatomegaly,
gallbladder not visualised
HIDA scan
Case 6
TFT raised TSH
 Urine for reducing substances
 Urine culture

Other differentials

Thank you