Neonatal Jaundice Year 4 Paediatrics Notes OmpathStudy

Neonatal Jaundice Year 4 · Paediatrics Collection: 4TH YEAR ALL NOTES / PAEDS / PAEDS 4.3 / Munge / NEONATOLOGY -- Slide 1 Neonatal Jaundice Dr Rose Munge Slide 2 Jaundice is the most common condition that requires medical attention and hospital readmission in newborns. The yellow coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin.\nIn most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon.\nIn some infants, serum bilirubin levels may rise excessively, which can be cause for concern because unconjugated bilirubin is neurotoxic and can cause death in newborns and lifelong neurologic sequelae in infants who survive (kernicterus) Slide 3 Neonatal physiologic jaundice results from simultaneous occurrence of the following two phenomena : 1. Bilirubin production is elevated because of increased breakdown of fetal erythrocytes.\n2. Hepatic excretory capacity is low both because of low concentrations of the binding protein ligandin in the hepatocytes and because of low activity of glucuronyl transferase, the enzyme responsible for binding bilirubin to glucuronic acid, thus making bilirubin water soluble (conjugation). Slide 4 In mother-infant pairs who are experiencing difficulties with the establishment of breast feeding, inadequate fluid and nutrient intake often leads to significant postnatal weight loss in the infant.\nSuch infants have an increased risk of developing jaundice through increased enterohepatic circulation, as described above.\nThis phenomenon is often referred to as breastfeeding jaundice and is different from the breast milk jaundice. Slide 5 Risk Factors Race: Incidence is higher in East Asians and American Indians and is lower in Africans/African Americans. Geography: Incidence is higher in populations living at high altitudes. Greeks living in Greece appear to have a higher incidence than those living outside of Greece. Genetics and familial risk: Incidence is higher in infants with siblings who had significant neonatal jaundice and particularly in infants whose older siblings were treated for neonatal jaundice.\nIncidence is also higher in infants with mutations/polymorphisms in the genes that code for enzymes and proteins involved in bilirubin metabolism, and in infants with homozygous or heterozygous glucose-6-phosphatase dehydrogenase (G-6-PD) deficiency and other hereditary hemolytic anemias. Slide 6 Nutrition: Incidence is higher in infants who are breastfed or who receive inadequate nutrition. \nWhen inadequate feeding volume is involved, increased enterohepatic circulation of bilirubin probably contributes to prolonged jaundice. Maternal factors: Infants of mothers with diabetes have higher incidence. Use of some drugs may increase the incidence, whereas others decrease the incidence. Some herbal remedies taken by the lactating mother may apparently exacerbate jaundice in the infant. Birthweight and gestational age: Incidence is higher in premature infants and in infants with low birthweight. Congenital infection Slide 7 Prognosis is excellent if the patient receives treatment according to accepted guidelines. Brain damage due to kernicterus remains a true risk, and the apparent increased incidence of kernicterus in recent years may be due to the misconception that jaundice in the healthy full-term infant is not dangerous and can be disregarded. Kernicterus is a complication of neonatal jaundice. Slide 8 Clinical Presentation Presentation and duration of neonatal jaundice Note the following: Typically, neonatal jaundice presents on the second or third day of life. Jaundice that is visible during the first 24 hours of life is likely to be nonphysiologic; needs further evaluation. Infants who present with jaundice after 3-4 days of life may also require closer scrutiny and monitoring. In infants with severe jaundice or jaundice that continues beyond the first 1-2 weeks of life, the results of the newborn metabolic screen should be checked for galactosemia and congenital hypothyroidism, further family history should be explored, the infant's weight curve should be evaluated, the mother's impressions as far as adequacy of breastfeeding should be elicited, and the stool color should be assessed. Slide 9 Family history Previous sibling with jaundice in the neonatal period, particularly if the jaundice required treatment Other family members with jaundice or known family history of Gilbert syndrome Anemia, splenectomy, or bile stones in family members or known heredity for hemolytic disorders Liver disease in family members History of pregnancy and delivery Maternal illness suggestive of viral or other infection Maternal drug intake, including the use of herbal remedies Delayed cord clamping Birth trauma with bruising and/or fractures. Slide 10 Postnatal History Loss of stool color Breastfeeding Use of drugs and herbal remedies in the lactating mother Greater than average weight loss Symptoms or