Prof. Saad Sal-Ani

Senior Pediatric Consultant

Head Of Pediatric department

Khorfakkan Hospital

04/11/23 2

04/11/23 3

04/11/23 4

04/11/23 5

04/11/23 6

04/11/23 7

04/11/23 8

Copyright ©2004 American Academy of Pediatrics

Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316

Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation

04/11/23 9

ASSESSING THE RISK OF JAUNDICE BY THE NUMBERS

Bhutani curveBhutani curve

04/11/23 10

KERNICTERUS Why we care about indirect hyperbilirubinemia Staining of the brain by bilirubin Early symptoms-acute bilirubin encephalopathy-

poor feeding, abnormal cry, hypotonia, Intermediate phase-stupor, irritability, hypertonia Late – shrill cry, no feeding, opisthotonus, apnea,

seizures, coma, death

04/11/23 11

KERNICTERUS Late sequelae can include

gaze abnormalitiesfeeding difficultiesdystoniaincoordinationchoreoathetosissensorineural hearing losspainful muscle spasms

04/11/23 12

RISK FACTORS FOR SIGNIFICANT JAUNDICE

Gestational Age Race Family history of jaundice requiring

phototherapy Hemolysis (ABO or other) Severe bruising Breastfeeding

04/11/23 13

RISK FACTORS-RACE Asians-highest risk Levels peak at 16-18 as opposed to average

Caucasian levels of 6-8. There is also a later peak which can occur at 5-7 days.

Black infants have a lower peak, rarely exceeding 12. (but they have a much higher incidence of G6PD deficiency)

Caucasians are in the middle.

04/11/23 14

RISK FACTORS-GESTATIONAL AGE

The younger the gestation, the higher the risk of jaundice.

37 weeks more prone to jaundice than 40 weeker who is more prone than a 42 weeker.

35 and below is much more prone Extreme preemies also more prone to

kernicterus and are treated at much lower levels.

04/11/23 15

RISK FACTORS-FAMILY HX A child whose sibling needed phototherapy is

12 times more likely to also have significant jaundice.

Frequently peak bilirubin levels correlate between siblings.

04/11/23 16

RISK FACTORS-HEMOLYSIS ABO Incompatibility is the most common cause of

hemolysis causing jaundice. Only 10-20% of infants with ABO mismatch develop

significant jaundice. Some of these infants, however, develop very significant

jaundice quickly. Coombs positive ABO is more likely to cause hemolysis,

but many babies will be asymptomatic. Conversely, Coombs negative ABO mismatch does occasionally cause significant hemolysis, but this is rather rare.

04/11/23 17

RISK FACTORS-PATHOLOGIC G6PD Deficiency Hereditary Spherocytosis Glucuronyl Transferase Deficiency Type 1

(Crigler Najar Syndrome) GT deficiency Type 2 (Arias Syndrome) Polycythemia

04/11/23 18