Jaundice
Dr.Abdulaziz Alsoumali
Intern
Alyamamh hospital Pediatric rotation
Content
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Definition of jaundice
Background & Epidemiology
Bilirubin metabolism
Classifications of jaundice
Causes of neonatal jaundice
Diagnosis
Treatment
Jaundice
Definition:
Definition
• Yellow discoloration of :
- The skin
- The conjunctival membrane (sclera)
• Jaundice is not a disease
• Bilirubin
Background & Epidemiology
- Over 50% of all newborn infants become visibly jaundiced.
- About 80% of pre-term newborn infants become jaundiced.
- The red cell half life span of newborn infants is (70 days)
- Hepatic bilirubin metabolism is less efficient in the
first few days of life.
Bilirubin metabolism
Classification
A) Unconjugated Hyperbilirubinemia
Hemolysis & Recticuloycytosis
(+) Coombs test
ABO & Rh
incompatibility
Autoimmune SLE
Idiopathic
acquired
hemolytic anemia
- Coombs test
RBC enzyme
defect (G6PD)
RBC membrane
defect
(spherocytosis)
No Hemolysis
Gilbert
syndrome
Physiologic
jaundice
Breast milk
jaundice
Breast feeding
Crigler-Najjar
syndrome
Hypothyrodisim
Pyloric stenosis
Classification
B) Conjugated Hyperbilirubinemia
Obstructive
Biliary atresia
Choledochal cyst
Cholelithiasis
Bile duct stenosis
Tumor/neoplasia
Spontanoeus bile
duct perforation
Bile-mucus plug
Infectious
Metabolic
Hepatitis
Cytomegalovirus
Herpes simplex
1,2,6
Epstein-Barr virus
Measles
Varicella
Bacterial sepsis
Cholecystitis
Wilson disease
Alpha-1
antitrypsin
deficiency
Galactosemia
Cystic fibrosis
Dubin-Johnson
Rotor syndrome
Classification
B) Conjugated Hyperbilirubinemia
Idiopathic
e.g. Idiopathic
neonatal hepatitis
Autoimmune
e.g. Autoimmune
chronic hepatitis
Sclerosing
cholangitis
Causes of neonatal jaundice
Diagnosis
(Clinical Assessment)
• Jaundice appears clinically --> the bilirubin level
reaches about 80 μmol/L
Complications
• Permanent damage
--> Kernicterus
- Athetoid cerebral palsy
- developmental delay
- hearing deficit
- dental dysplasia
- Permanent upward gaze
(Parinaud’s sign)
Complications
• Reversible damage
--> Acute bilirubin
encephalopathy
• Initial signs include: - lethargy
- hypotonia
- poor suck, progressing to
- hypertonia
(opisthotonos&retrocollis)
- High pitched cry
Treatment
• Phototherapy
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Complications:
Loose stools
Erythematous macular rash
Overheating --> leading to dehydration
Bronze baby syndrome
• Exchange transfusion
- no response with phototherapy
- reaches the threshold of the transfusion
Take home message
Literatures
• Up to date
• Tom Lissauer, Graham Clayden. Illustrated
textbook of Pediatrics, 4th edition
• NELSON, Essentials of pediatrics
• Queensland Maternity and Neonatal Clinical
guideline
• NICE guidelines for neonatal jaundice
Questions !!