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Jaundice (Jaune: French): Yellow color seen on the skin & eyes (sclera tissue) of

newborns.
-Neonatal jaundice is also known as Unconjugated hyperbilirubinemia
-60% full-term & 85% preterm Singaporean baby
-2 types: Physiological & pathological
+ Physiological: after 24hrs, fade by 1 wk. Not exceed 200-215 umol/L (12-
13mg/dL)
+ Pathological: visible within 24 hrs, persistent till 2wks. Not exceed 200umol/L
(increase >85umol/L [5 mg/dl] per day)
(RBC beak down by phagocytes at Liver, Spleen, Lymph nodes  Globin & Heme)
(Globin  amino acid  circulation)
(Heme  Fe  transferrin  Liver)
(Heme w-out Fe: Protoporphyrin  Unconjugated bilirubin UCB  lipid-soluble 
Albumin  Liver  Hepatocyte  UGT: Uridine glucuronyl transferase 
Conjugated bilirubin CB  Water soluble  Bile(Water-soluble)  Intestinal
bacteria  Urobilin & Stercobilin)
Before birth other liver do all the things
Etiology: Bilirubin builds up in baby’s blood and subsequently deposit in elastin-
rich tissue. Occur to babies of any race.
Newborn  low UGT enzyme @ liver
-Earliest sign: looking at the eyes (sclera  white part)
Phototherapy: change in bilirubin molecule by absorb E from light & change shape
 more soluble  urine

Newborn:
1. Increase Hemoglobin release X 2,3 times adult  increase bilirubin
Increase HCT (50-60% comparing Men 46%, Women it is 42%) The
volume of red blood cells compared to the total blood volume (red
blood cells and plasma) + shorter RBC lifespan (60-90days, preterm:
35-50 days)
2. Decrease bilirubin clearance
Immature enzyme (1% activity of adult in 1st week age)
3. Increase enterohepatic circulation
More bilirubin is reabsorbed from GI tract

2 confirm jaundice: blood test  bilirubin level before 24hrs old.


Prick @ heel Total serum bilirubin level
Use light to measure bilirubin level on skin

Treatment: Phototherapy:
Special type of light not sunlight. Blue because it has the spectrum
that bilirubin can most strongly absorbed by bilirubin. photo-oxidation. Photo-oxidation
adds oxygen to the bilirubin so it dissolves easily in water

In adults, prolonged exposure to blue light can cause retinal damage. Although retinal
damage from phototherapy has not been reported, eye covers for newborns are standard
prophylaxis.

Double and Single blue

There are no specific guidelines for when to discontinue phototherapy. Evidence of hemolysis and
age of the infant will impact the duration. In some cases, phototherapy will only be needed for 24
hours or less, in some cases, it may be required for 5 to 7 day. readmitted for hyperbilirubinemia,
with a level of 18 mg/dL or more, should have a level of 13 - 14 mg/dL in order to discontinue
phototherapy.