1 Neonatal Jaundice

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Neonatal Jaundice

  • Jaundice is visible in newborn skin when bilirubin > 5 mg/dl
  • Progression - CephaloCaudal

Kramer's Rule/Zones :





Zone    Bilirubin
 1 ----- 5 mg/dl
 2 ----- 10
 3 ----- 12
 4 ----- 15
 5 ----- >15












  • 1g Hb = 34 mg Bilirubin = 1.34 ml O2

  • 1g/dl of Albumin binds 8mg Bilirubin











  • The bilirubin gets conjugated in Liver (via UDP Glucuronyl Transferase).
  • Unconjugated Unbound bilirubin causes Kernicterus.

 Physiological Jaundice of Newborn 

Reasons :
  1. Hematocrit of Newborn is more
  2. Life span of fetal RBC = 90days {Adult is 120}
  3. Y Ligandin - Low
  4. UDP - GT - Low
  5. Excretion - Less
  6. Enterohepatic circulation More

In Term babies - Peaks on day 3 and normal in 7 days (Peak upto 12 mg/dl)

In Pre-term babies - Peaks on Day 5 , normal in 14 days (Peak upto 15mg/dl)

i.e >15mg/dl is Pathological { Palms and Soles - Yellow (see Kramer zones above) }


 Pathological Jaundice 

1. Jaundice on Day 1

2. If
  • Mother Rh - , Child Rh +
  • Cord Blood Hb <10 g %
  • Corl Blood Bilirubin > 5 mg %
  • Direct Coomb's +ve
This is an Indication for Exchange transfusion.

3. if Bilirubin increase rate > 0.5 mg/dl/hr

4. If Jaundice persists
  • >7days in term 
  • >14days in preterm 
5. Jaundice which require therapy.

Most important cause - Rh incompatibility.

Other causes:
  • Minor blood group incompatibility
  • ABO incompatibility
  • Spherocytosis , Elliptocytosis
  • RBC enzyme deficiency - G6PD def , Pyruvate Kinase def.

T/t - 
  • Phototherapy
  • Exchange transfusion


 Phototherapy ( 425 - 475 nm ) - Blue White Light

Water insoluble bilirubin ------> Water Soluble -----> Excreted

Mechanism:
  1. Structural Isomerization (Bilirubin to Lumirubin) (Irreversible)
  2. Photoisomerization
  3. Photo-Oxidation
  • Child 40 cm away from tube.
  • 4 - 6 mg/day fall of bilirubin.

Side effects :
  1. Fever , dehydration ( therefore do frequent feeding or increase IV fluids by 20%)
  2. Retinal Damage (so cover eyes)
  3. Mutations in Gonads (so cover gonads too)
  4. Hypocalcemia
  5. Diarrhoea (watery) - because of bile pigments in gut.
  6. Contraindicated in Conjugated Jaundice (Hepatitis) - else Bronze baby syndrome. 

Persistence / Exaggeration of Physiological Jaundice :
  1. Congenital Hypothyroidism
  2. IVH , Cephalhematoma
  3. Battered baby syndrome
  4. Crigler Najjar Type II / partial deficiency of UDP-GT (Needs life long phototherapy)
  5. Breast Milk Jaundice

Note : In Crigler Najjar Type I - UDP - GT is absent - so all have kernicterus and die.


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