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Dr.Abdulaziz Alsoumali Intern Alyamamh hospital Pediatric rotation Dr.Abdulaziz Alsoumali Intern...
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Transcript of Dr.Abdulaziz Alsoumali Intern Alyamamh hospital Pediatric rotation Dr.Abdulaziz Alsoumali Intern...
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Dr.Abdulaziz AlsoumaliIntern
Alyamamh hospital Pediatric rotation
Jaundice
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Content
• Definition of jaundice • Background & Epidemiology • Bilirubin metabolism • Classifications of jaundice• Causes of neonatal jaundice • Diagnosis • Treatment
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Jaundice
Definition:
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Definition
• Yellow discoloration of : - The skin - The conjunctival membrane (sclera) • Jaundice is not a disease • Bilirubin
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Background & Epidemiology
- Over 50% of all newborn infants become visibly jaundiced.
- About 80% of pre-term newborn infants become jaundiced.
- The red cell half life span of newborn infants is (70 days)
- Hepatic bilirubin metabolism is less efficient in the first few days of life.
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Bilirubin metabolism
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Classification A) Unconjugated Hyperbilirubinemia
Hemolysis & Recticuloycytosis No Hemolysis
(+) Coombs testABO & Rh
incompatibility Autoimmune SLE
Idiopathic acquired
hemolytic anemia
- Coombs testRBC enzyme
defect (G6PD)RBC membrane
defect (spherocytosis)
Gilbert syndrome Physiologic
jaundiceBreast milk jaundice
Breast feedingCrigler-Najjar
syndrome Hypothyrodisim
Pyloric stenosis
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Obstructive Infectious Metabolic
Classification B) Conjugated Hyperbilirubinemia
Biliary atresia Choledochal cyst
CholelithiasisBile duct stenosisTumor/neoplasiaSpontanoeus bile duct perforationBile-mucus plug
Hepatitis Cytomegalovirus Herpes simplex
1,2,6Epstein-Barr virus
MeaslesVaricella
Bacterial sepsisCholecystitis
Wilson diseaseAlpha-1
antitrypsin deficiency
GalactosemiaCystic fibrosis Dubin-Johnson
Rotor syndrome
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e.g. Idiopathic neonatal hepatitis
e.g. Autoimmune chronic hepatitis
Sclerosing cholangitis
Classification B) Conjugated Hyperbilirubinemia
Idiopathic Autoimmune
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Causes of neonatal jaundice
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Diagnosis(Clinical Assessment)
• Jaundice appears clinically --> the bilirubin level reaches about 80 μmol/L
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• Permanent damage --> Kernicterus
- Athetoid cerebral palsy - developmental delay - hearing deficit - dental dysplasia - Permanent upward gaze (Parinaud’s sign)
Complications
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Complications
• Reversible damage --> Acute bilirubin encephalopathy
• Initial signs include: - lethargy - hypotonia - poor suck, progressing to - hypertonia (opisthotonos&retrocollis) - High pitched cry
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Treatment
• Phototherapy Complications: Loose stools Erythematous macular rash Overheating --> leading to dehydration Bronze baby syndrome
• Exchange transfusion - no response with phototherapy - reaches the threshold of the transfusion
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Take home message
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• Up to date• Tom Lissauer, Graham Clayden. Illustrated
textbook of Pediatrics, 4th edition • NELSON, Essentials of pediatrics • Queensland Maternity and Neonatal Clinical
guideline • NICE guidelines for neonatal jaundice
Literatures
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Questions !!