NEONATAL JAUNDICE

BY

DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER / CONSULTANT PAEDIATRICIAN H.O.D, DEPT OF PAEDIATRICS,

DELSU & DELSUTH.

MEDICAL DIRECTOR RAPHA SPECIALIST CHILDREN & GENERAL CLINIC, 85

AIRPORT ROAD, EFFURUN.

PRE - TEST

• What the causes jaundice in neonates?

• How is jaundice diagnosed?

• What is physiologic jaundice?

• Which of the following is useful for Rx :

(a) Early morning sunlight

(b) Glucose + Ampiclox

(c ) Phenobarbitone

LEARNING OBJECTIVES

• DEFINE JAUNDICE

• PATHOPHYSIOLOGY OF JAUNDICE

• DANGER OF JAUNDICE

• DEBUNKING WRONG TREATMENTS

• EMPHASIZING PROMPT & EFFECTIVE

TREATMENT

INTRODUCTION

DEFINITION

PREVALENCE

BURDEN OF THE DISEASE

BILIRUBIN METABOLISM

• SOURCES OF BILIRUBIN• HEMOLYSIS• BILIRUBIN BINDING TO ALBUMIN• LIVER UPTAKE• BINDING TO LIGADIN Y & Z• CONJUGATION WITH UDPGT• EXCRETION INTO BILE• ENTEROHEPATIC CIRCULATION

PHYSIOLOGIC JAUNDICE

• DEFINITION

• CAUSES

• - RBC VOL ,RBC SURVIVAL,ELB,EHC

• -DEFECTIVE UPTAKE

• -DEFECTIVE CONJUGATION

• -REDUCED EXCRETION

• RATE OF RISE AND PEAK

PATHOLOGIC JAUNDICE

• DEFINITION

• CAUSES

• -POLYCYTHAEMIA

• -HEMOLYSIS

• -BILIRUBIN DISPLACEMENT

• -HEPATOBILIARY DISEASES

• RATE OF RISE AND PEAK

BILIRUBIN TOXICITY

• PATHOLOGY: UNCOUPLING OF OXIDATIVE PHOSPHORILATION, NEURONAL CELL DEATH

• WORSE HIT:BASALGANGLIA,GLOBUS PALLIDUS,PUTAMEN,CAUDATE

NUCLEI• + CH, BULBAR & CEREBELLAR

NUCLEI

CLINICAL STAGING

1.POOR MORO,HYPOTONIA,LETHARGY POOR FEEDING, HIGH PITCH CRY2.OPISTHOTONUS,HYPERTONIA,FEVER SEIZURES,ROWING “BICYCLING” PARALYSIS OF UPWARD GAZE3.APPARENT RECOVERY4.LATE SEQUELAE: SPASTICITY,ATHETOSIS COMPLETE OR PARTIAL DEAFNESS, CP, MR

CLINICAL EVALUATION

• VISUAL ESTIMATION(ROUGH GUIDE)

• SB (TOTAL & CONJUGATED)

• PCV & COOMBS

• CONJ BIL < 2mg% VERSUS > 2mg %

• PCV HIGH VS NORMAL OR LOW

• RETIC NORMAL VS ABNORMAL

TREATMENT

• PHOTOTHERAPY:INDICATIONS,MOA

LIGHT SOURCE, TECHNIQUE, PHOTO

BLANKET• EBT; INDICATIONS,MOA, TECHNIQUE• PHENOBARBITONE: MOA, DEMERITS

CONTEMPORARY INDICATIONS• ACTIVATED CHARCOL• TIN PROTOPORPHYRIN

CONCLUSION

• NO ROASTING OF BABY IN THE SUN

• NO AMPICLOX AND GLUCOSE

• NO DELAY TO REFER BABY

• STOP CEREBRAL PALSY PLEASE!!!!!