Neonatal JaundiceSGD

Dr SaffiullahAP Paeds

Learning outcomes

By the end of this discussion you should be able to;1.Make a differential diagnosis of common and

significant causes of jaundice in neonates2.Differentiate between physiological and pathological

jaundice including persistent jaundice in neonates3.Organise investigations for neonates presenting with

jaundice4.Management of common and significant causes of

neonatal jaundice5.Indications and side effects of different treatment

modalities of neonatal jaundice including phototherapy

Physiologic jaundice

◦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

Pathologic 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 .

Case 1

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 2

SBR 20 mainly indirectHb 10, wbc 8000 and platelets 300000Mothers blood group O Rh positive, Baby’s

A Rh positiveCoombs test positive

Case 3

SBR 20 mainly indirectHb 10, wbc 8000 and platelets 300000Mothers blood group B Rh negative,

Baby’s A Rh positiveCoombs test positive

Case 4

SBR 20 mainly indirectHb 10, wbc 8000 and platelets 300000Mothers blood group A Rh positive, Baby’s

A Rh positiveCoombs test negativeBlood film showed spherocytes

Case 5

SBR 20 mainly indirectHb 10, wbc 20000 and platelets 300000Mothers blood group A Rh positive, Baby’s

A Rh positiveC reative protein CRP 150Coombs test negative

Case 6

SBR 20 mainly indirectHb 10, wbc 8000 and platelets 300000Mothers blood group A Rh positive, Baby’s

A Rh positiveCoombs test negativeG6PD low

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 0

50

100

150

200

250

300

350

400

450

500

550

Exchange transfusion

Phototherapy

Days from birth

Tota

l ser

um b

iliru

bin

(mic

rom

ol/l

itre)

MultipleSingle

Side effects of phototherapy

Increased water lossDiarrheaRetinal damageBronze baby, tanningMutations in DNA? shield scrotumDisturb of mother-infant interaction

Case 6

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 indirectHb 15, wbc 8000 and platelets 300000Mothers blood group O Rh positive, Baby’s

O Rh positiveCoombs test negativeUltrasound abdomen hepatomegaly,

gallbladder not visualisedHIDA scan

Other differentials

TFT raised TSHUrine for reducing substancesUrine culture

Thank you