Question

Discuss jaundice signs & symptoms in New Born and explain rationales for therapy.

Discuss the dialogue you would use to teach a new mother about physiologic jaundice.

Include why the time of onset of the jaundice is important and how to treat jaundice.

Please include references.

Answer 1

NEONATAL JAUNDICE

Definition-

Jaundice (icterus) refers to the yellow appearance of the skin, sclera and mucous membranes resulting from an increased bilirubin concentration (hyperbilirubinaemia) in the body fluids. Clinically, jaundice is detectable when the plasma bilirubin exceeds 2–3 mg/dL.

SIGNS / SYMPTOMS OF JAUNDICE IN NEWBORN

• Bright yellow skin colour ( appears in cephalo - caudal direction as serum bilirubin increases)
• Lethargy
• Poor feed
• Kernicterus and seizures in complicated cases of Pathological Jaundice

Physiological jaundice of newborn ( Icterus Neonatorum)

• It appears within 2–5 days of birth and usually disappears in 2 weeks.
• It occurs due to excessive destruction of RBCs occuring  in first few days after birth causing increase in the serum bilirubin.
• Hepatic immaturity in the first few (7–10) days after birth also contributes to increased serum bilirubin.Immediately after birth, liver performs function of bilirubin conjunction. It  takes 7–10 days for liver to get mature and fully conjugate the bilirubin

NOTE:

ADVICE TO MOTHER-

If signs and symptoms of hyperbilirubinemia are appearing on day 1 after birth then it is not physiological . This is pathological jaundice and requires urgent attention.

Keep observing the colour of skin of newborn

Keep a check on feeding pattern

Report to health care staff if their is a doubt and go for blood investigation for serum bilirubin.

Complications after phototherapy may include loose stool, erythema, dehydration, bronze baby syndrome.

Rationale of treatment

Treatment plan depends upon

• the day of onset of baby
• gestation
• weight of baby.

PHOTOTHERAPY
Hyperbilirubinemia can be effectively treated by phototherapy.
Phototherapy is initiated when the bilirubin levels in serum starts rising
Narrow spectrum blue , blue lights are efficient in reducing bilirubin levels.
Bilirubin in skin absorbs white light and causes Photochemical reactions.
Exposure of the skin to white light causes photoisomerization of bilirubin to water-soluble lumirubin and 15Z - bilirubin  ( an isomer if bilirubin) which can be rapidly excreted without requiring any conjugation.

Photo therapy is discontinued when bilirubin level falls below 13-14 mg/ dl

EXCHANGE TRANSFUSION

Requirement of exchange transfusion depends on

• Trend of serum bilirubin levels and response to treatment ( Total serum bilirubin more than 25 mg / dl )
• Clinical presentation of infant (signs of bilirubin encephalopathy)
• Underlying condition
• Previous treatment