Jaundice

Manaen

Neonatal

Framework

• The definition of Neonatal Jaundice• Billirubin Metabolism• Special characteristic in neonates• Dangerous of the Hyperbillirubinemia• The diseases in relation with Neonatal

Jaundice

What is the Neonatal Jaundice?

• Neonatal Jaundice(also called Newborn jaundice) is a condition marked by high levels of bilirubin in the blood.

The increased bilirubin cause the infant's skin and whites of the eyes (sclera) to look yellow.

Billirubin Metabolism

Special characteristic in neonates

• 1.More billirubin produced• Much more Hemolysis• The life-length of hemolysis(70~80)

Special characteristic in neonates

• 2.The low capability of albumin on unconjugated billirubin transportation

• acid intoxication• Less albumin in neonates

Special characteristic in neonates

• 3.The low capability of heptatocyte• Less Y protein and Z protein• The primary development of Hepato-

enzyme system• Easy-broken hepato-enzyme system• After-born, the blood glucose level is very low.

Special characteristic in neonates

• 4.High workload of the hepato-enteric circulation

• Less bacterial• Low enzymatic activity in intestine• High level of billirubin in meconium

A little examIncreased rbc’sIncreased rbc’s

Shortened rbc lifespanShortened rbc lifespan

Immature hepatic uptake & conjugationImmature hepatic uptake & conjugation

Increased enterohepaticCirculationIncreased enterohepaticCirculation

The general symptom of neonatal jaundice

• Yellow skin • Yellow eyes(sclera)• Sleepiness• Poor feeding in infants• Brown urine• Fever• High-pitch cry• Vomiting

Brown urine

Grading of extent of jaundice 1

Area of body Billirubin levelsmg/dl (*17=umol)

Face 4-8Upper trunk 5-12Lower trunk & thighs 8-16Arms and lower legs 11-18Palms & soles > 15

Grading of extent of jaundice 2

Hemolytic disease of newborn

This condition occurs when there is an incompatibility between the blood types of the mother and baby.

Are they use the same circulation system?

Placental barrier

• ..

The blood types(A, B, O, AB)

• Although it is not as common (especially in a first pregnancy), a similar problem of incompatibility may happen between the blood types (A, B, O, AB) of the mother and baby in the following situations:

The blood types(A, B, O, AB)

The blood types (Rh)

Kernicterus• Kernicterus is damage to the brain centers of

infants caused by increased levels of unconjugated-indirect bilirubin which is free (not bound to albumin).

Blood-brain barrier

The symptoms

• Eye movement obstacles

• Hearing disorder