Neonatal Jaundice – Pediatrics
Summary (MBBS 4th Year)
NEONATAL JAUNDICE
DR MALEMBEKA-NG’ONGA
Outline
Definition of jaundice
Metabolism of bilirubin
Types of jaundice
Causes of neonatal jaundice
Management of neonatal jaundice
Introduction
Jaundice is the yellow discoloration of the skin, sclerae and mucus
membranes due to hyperbilirubinemia (high bilirubin)
Clinical jaundice is observed when serum bilirubin is >5mg/dl//86
mmol/L (newborn)
The incidence of neonatal jaundice:
term neonates occurs in 50%
Preterm neonates occurs in 80%
Baby with neonatal jaundice
Types of bilirubin
Mechanism of neonatal jaundice
increased bilirubin load due to high Hb concentration
Normal newborn infant
Hemolysis
Cephalohematoma or bruising
polycythemia
Decrease bilirubin conjugation in the liver
Decreased uridine glucuronyl transferase activity
Glucuronyl transferase deficiency type 1
Defective bilirubin excretion
1. Biliary atresia
, 2. Neonatal hepatitis
Etiology
Physiological jaundice
Most common cause of neonatal jaundice
It is due to increased bilirubin production from the breakdown of fetal
RBCs combined with transient limitation in the conjugation of bilirubin
by the immature neonatal liver.
There is decreased glucuronyl transferase enzyme activity
Short life span of neonatal RBC's (40-60 days) during the first week
Risk factors of jaundice
A sibling with neonatal jaundice or anaemia
ABO, Rh incompatibility
UDP-glucuronyl transferase deficiency (Criggler-Najjar, Gilbert’s
disease)
Reduced feeding (formula or breastfeeding)
Infection (viral, bacterial)
Infant of diabetic mother (macrosomia)
Prematurity
Cephalohematoma or bruising
Haematocrit >65% (polycythaemia)
East Asian, Mediterranean, Native American heritage
Pathological Jaundice
Can either be unconjugated or conjugated
Causes of conjugated hyperbilirubinemia:
Defective excretion due to bile flow obstruction
Defective secretion of conjugated bilirubin by hepatocytes
Causes of unconjugated hyperbilirubinemia:
increased production of bilirubin
decreased conjugation of bilirubin
Over production of bilirubin
1. Increased rate of hemolysis (breakdown)
Rh. incompatibility
ABO blood group incompatibility
Spherocytosis.
alpha Thalassemia
Summary (MBBS 4th Year)
NEONATAL JAUNDICE
DR MALEMBEKA-NG’ONGA
Outline
Definition of jaundice
Metabolism of bilirubin
Types of jaundice
Causes of neonatal jaundice
Management of neonatal jaundice
Introduction
Jaundice is the yellow discoloration of the skin, sclerae and mucus
membranes due to hyperbilirubinemia (high bilirubin)
Clinical jaundice is observed when serum bilirubin is >5mg/dl//86
mmol/L (newborn)
The incidence of neonatal jaundice:
term neonates occurs in 50%
Preterm neonates occurs in 80%
Baby with neonatal jaundice
Types of bilirubin
Mechanism of neonatal jaundice
increased bilirubin load due to high Hb concentration
Normal newborn infant
Hemolysis
Cephalohematoma or bruising
polycythemia
Decrease bilirubin conjugation in the liver
Decreased uridine glucuronyl transferase activity
Glucuronyl transferase deficiency type 1
Defective bilirubin excretion
1. Biliary atresia
, 2. Neonatal hepatitis
Etiology
Physiological jaundice
Most common cause of neonatal jaundice
It is due to increased bilirubin production from the breakdown of fetal
RBCs combined with transient limitation in the conjugation of bilirubin
by the immature neonatal liver.
There is decreased glucuronyl transferase enzyme activity
Short life span of neonatal RBC's (40-60 days) during the first week
Risk factors of jaundice
A sibling with neonatal jaundice or anaemia
ABO, Rh incompatibility
UDP-glucuronyl transferase deficiency (Criggler-Najjar, Gilbert’s
disease)
Reduced feeding (formula or breastfeeding)
Infection (viral, bacterial)
Infant of diabetic mother (macrosomia)
Prematurity
Cephalohematoma or bruising
Haematocrit >65% (polycythaemia)
East Asian, Mediterranean, Native American heritage
Pathological Jaundice
Can either be unconjugated or conjugated
Causes of conjugated hyperbilirubinemia:
Defective excretion due to bile flow obstruction
Defective secretion of conjugated bilirubin by hepatocytes
Causes of unconjugated hyperbilirubinemia:
increased production of bilirubin
decreased conjugation of bilirubin
Over production of bilirubin
1. Increased rate of hemolysis (breakdown)
Rh. incompatibility
ABO blood group incompatibility
Spherocytosis.
alpha Thalassemia
