Beruflich Dokumente
Kultur Dokumente
Sahisnuta Basnet
PHYSIOLOGY
• Destruction of circulating senescent
RBC accounts for 75% of daily bilirubin
production
• Rest 25%- turnover of nonHb heme
proteins and destruction of immature
&ineffective RBC
• 1gm of Hb-35 mg bilirubin amounting
to 6-10 mg/kg/day of bilirubin
Physiology
• Bilirubin is from breakdown of hemoglobin
• Unconjugated bilirubin transported to liver
– Bound to albumin because insoluble in water
• Transported into hepatocyte & conjugated
• Primarily bound to ligandin within the cell & this
prevents the backflow into circulation
– With glucuronic acid → now water soluble
(by action of uridine diphosphate gluconoryl
transferase)
• Secreted into bile
• In ileum & colon, converted to
urobilinogen
• Excreted from urine as urobilin
• Excreted from feces as stercobilin
Bilirubin Metabolism
Unconjugated
Glucuronyl Transferase
(Bilirubin Diglucuronide)
Why do newborns
develop jaundice?
Increased production (↑RBC mass, so ↑ed hemolysis
Fetus is in a hypoxic environment – high Hb
Postnatal rise in PO2
Decrease in erythropoietin prodn.
Destruction of excess Hb.
• Phototherapy
• Drugs
• Exchange
transfusion
Indications for Phototherapy
• TSB > 15 mg % in term
• TSB > 12 mg% in preterm
• TSB > 5 mg% within 24 hours
• Adjuvant to exchange transfusion
• VLBW with Perinatal risk factors
• Precautions
– Cover the eyes and Genitals
– Supplemental hydration
– Watch for side effects
PHOTOTHERAPY
• Blue light (425-475 nm)
• Fibreoptic blankets or overhead banks
• As close as possible ( 25cm)
• Continuos therapy-interruptions for
feeding allowed
Mechanism Of Phototherapy