1. Due to low oxygen tension in fetal blood , the fetus has a high hemoglobin and hematocrit.

2. At birth , oxygen tension increases and the extra RBCs are no longer needed .

3. The infant begins breaking down the excessive RBCs.

4. As RBCs are broken down , indirect bilirubin is released .

5. Indirect bilirubin (unconjugated) is fat soluble.

6. The liver converts indirect bilirubin to direct bilirubin (conjugated), which is water soluble and can be excreted in the urine.

7. In the normal newborn , the direct bilirubin reaches its peak at about three days of life and then starts to decrease. This is termed physiologic jaundice .

8. In a child with hyperbilirubinemia , the indirect bilirubin level may start climbing within hours of birth or the level of indirect bilirubin is excessive interfering with brain function.

9. Normal indirect (unconjugated) bilirubin levels are below 1.4mg/dl.

Following birth , the liver is unable to convert indirect bilirubin to direct bilirubin adequately.

The direct bilirubin builds up In the blood and collects in fat-richtissue including the skin and thelining of the brain.

When the indirect bilirubin level reaches toxic range, the brain will be affected .

This bilirubin encephalopathy is called kernicterus.

Any condition that stresses the liver will delay the conjugation and increase the risk of hyperbilirubinemia.

Causes of hyperbilirubinemia , include RH and ABO incompatibility , prematurity and immaturity , any injury which increases blood cell destruction such as bruising , petechiae , and hematomas, infant of a diabetic mother , cold stress , infection , and breast-feeding.

Yellow appearance to the skin : The skin discoloration begins on the face and spreads caudally . Sclera also appear yellow .

As kernicterus develops , additional symptoms may be seen . Such as :

1. Poor feeding.

2. High pitched shrill cry .

3. Lethargy or irritability .

Based on bilirubin levels

Liver function test .

blood tests

ultrasound scan.

CT

MRI

Phototherapy . Exchange transfusions are done only in the most extreme cases.

Intravenous immunoglobulin

Sepsis in bile ducts.

Biliary cirrhosis.

Pancreatitis

Coagulopathy

Hepatic and renal failure.

1. Provide phototherapy , which slowly converts the indirect bilirubin on the skin surface so that it can be excreted . It is important that the treatment be continuous.

2. Ensure that the child is uncovered except genitalia and eyes

3. Cover the eyes with occlusive pads

4. Turn the infant frequently

5. . A Use no lotions or oils on the infant’s skin to prevent burning

6. Provide extra water feeding

7. Maintain body temperature within normal limits

8. Provide diaper care frequently as the stool tend to be loose and irritating