Neonatal Jaundice

A practical approach

 Kernicterus & neurologic

sequelae : preventable
conditions.
Structured and practical
approach
Primary prevention
ensuring adequate feeding,
breastfed infants: 8 to 12 feedings per
24 hours.

Secondary prevention

 benign
identify those at risk of developing
bilirubin-induced neurologic dysfunction.
Acute bilirubin encephalopathy
toxic effects of unconjugated bilirubin on the
CNS
lethargy, high-pitched cry, and poor feeding
untreated : progress rapidly to advanced
manifestations, eg: opisthotonus and seizures

Kernicterus
chronic, permanent clinical sequelae
of bilirubin toxicity
severe athetoid cerebral palsy,
paralysis of upward gaze, hearing
loss, and intellectual impairment
Preventable!!!

History
1950s : exchange transfusion
late 1960s : phototherapy
1980s and 1990s : resurgence of
kernicterus
early hospital discharge,
the influence of managed care, and
an increase in the number of breastfed infants
increase in breastfeeding inadequacy in the
first week of life

Bilirubin Metabolism
catabolism of hemoglobin.
high rate of hemoglobin catabolism
because of their elevated hematocrit
and red blood cell volume per body
weight,
their shorter life span of red blood
cells (70 to 90 days).
conjugation and clearance of bilirubin
can be slow.

Primary Prevention: Preventing Jaundice

Secondary Prevention: Assessing At-Risk Infants