NEONATAL JAUNDICE
BY
DR BLESSING OFEJIRO OKPERI
B.Med.Sc.(Hons), MBBS, FWACP (Paed)
SENIOR LECTURER / CONSULTANT PAEDIATRICIAN
H.O.D, DEPT OF PAEDIATRICS,
DELSU & DELSUTH.
MEDICAL DIRECTOR
RAPHA SPECIALIST CHILDREN & GENERAL CLINIC,
85 AIRPORT ROAD, EFFURUN.
PRE - TEST
• What the causes jaundice in neonates?
• How is jaundice diagnosed?
• What is physiologic jaundice?
• Which of the following is useful for Rx :
(a) Early morning sunlight
(b) Glucose + Ampiclox
(c ) Phenobarbitone
LEARNING OBJECTIVES
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DEFINE JAUNDICE
PATHOPHYSIOLOGY OF JAUNDICE
DANGER OF JAUNDICE
DEBUNKING WRONG TREATMENTS
EMPHASIZING PROMPT & EFFECTIVE
TREATMENT
INTRODUCTION
DEFINITION
PREVALENCE
BURDEN OF THE DISEASE
BILIRUBIN METABOLISM
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SOURCES OF BILIRUBIN
HEMOLYSIS
BILIRUBIN BINDING TO ALBUMIN
LIVER UPTAKE
BINDING TO LIGADIN Y & Z
CONJUGATION WITH UDPGT
EXCRETION INTO BILE
ENTEROHEPATIC CIRCULATION
PHYSIOLOGIC JAUNDICE
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DEFINITION
CAUSES
- RBC VOL ,RBC SURVIVAL,ELB,EHC
-DEFECTIVE UPTAKE
-DEFECTIVE CONJUGATION
-REDUCED EXCRETION
RATE OF RISE AND PEAK
PATHOLOGIC JAUNDICE
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DEFINITION
CAUSES
-POLYCYTHAEMIA
-HEMOLYSIS
-BILIRUBIN DISPLACEMENT
-HEPATOBILIARY DISEASES
RATE OF RISE AND PEAK
BILIRUBIN TOXICITY
• PATHOLOGY: UNCOUPLING OF
OXIDATIVE PHOSPHORILATION,
NEURONAL CELL DEATH
• WORSE HIT:BASALGANGLIA,GLOBUS
PALLIDUS,PUTAMEN,CAUDATE
NUCLEI
• + CH, BULBAR & CEREBELLAR
NUCLEI
CLINICAL STAGING
1.POOR MORO,HYPOTONIA,LETHARGY
POOR FEEDING, HIGH PITCH CRY
2.OPISTHOTONUS,HYPERTONIA,FEVER
SEIZURES,ROWING “BICYCLING”
PARALYSIS OF UPWARD GAZE
3.APPARENT RECOVERY
4.LATE SEQUELAE: SPASTICITY,ATHETOSIS
COMPLETE OR PARTIAL DEAFNESS, CP, MR
CLINICAL EVALUATION
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VISUAL ESTIMATION(ROUGH GUIDE)
SB (TOTAL & CONJUGATED)
PCV & COOMBS
CONJ BIL < 2mg% VERSUS > 2mg %
PCV HIGH VS NORMAL OR LOW
RETIC NORMAL VS ABNORMAL
TREATMENT
• PHOTOTHERAPY:INDICATIONS,MOA
LIGHT SOURCE, TECHNIQUE, PHOTO
BLANKET
• EBT; INDICATIONS,MOA, TECHNIQUE
• PHENOBARBITONE: MOA, DEMERITS
CONTEMPORARY INDICATIONS
• ACTIVATED CHARCOL
• TIN PROTOPORPHYRIN
CONCLUSION
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NO ROASTING OF BABY IN THE SUN
NO AMPICLOX AND GLUCOSE
NO DELAY TO REFER BABY
STOP CEREBRAL PALSY PLEASE!!!!!