Dr.Abdulaziz AlsoumaliIntern

Alyamamh hospital Pediatric rotation

Jaundice

Content

• Definition of jaundice • Background & Epidemiology • Bilirubin metabolism • Classifications of jaundice• Causes of neonatal jaundice • Diagnosis • Treatment

Jaundice

Definition:

Definition

• Yellow discoloration of : - The skin - The conjunctival membrane (sclera) • Jaundice is not a disease • Bilirubin

Background & Epidemiology

- Over 50% of all newborn infants become visibly jaundiced.

- About 80% of pre-term newborn infants become jaundiced.

- The red cell half life span of newborn infants is (70 days)

- Hepatic bilirubin metabolism is less efficient in the first few days of life.

Bilirubin metabolism

Classification A) Unconjugated Hyperbilirubinemia

Hemolysis & Recticuloycytosis No Hemolysis

(+) Coombs testABO & Rh

incompatibility Autoimmune SLE

Idiopathic acquired

hemolytic anemia

- Coombs testRBC enzyme

defect (G6PD)RBC membrane

defect (spherocytosis)

Gilbert syndrome Physiologic

jaundiceBreast milk jaundice

Breast feedingCrigler-Najjar

syndrome Hypothyrodisim

Pyloric stenosis

Obstructive Infectious Metabolic

Classification B) Conjugated Hyperbilirubinemia

Biliary atresia Choledochal cyst

CholelithiasisBile duct stenosisTumor/neoplasiaSpontanoeus bile duct perforationBile-mucus plug

Hepatitis Cytomegalovirus Herpes simplex

1,2,6Epstein-Barr virus

MeaslesVaricella

Bacterial sepsisCholecystitis

Wilson diseaseAlpha-1

antitrypsin deficiency

GalactosemiaCystic fibrosis Dubin-Johnson

Rotor syndrome

e.g. Idiopathic neonatal hepatitis

e.g. Autoimmune chronic hepatitis

Sclerosing cholangitis

Classification B) Conjugated Hyperbilirubinemia

Idiopathic Autoimmune

Causes of neonatal jaundice

Diagnosis(Clinical Assessment)

• Jaundice appears clinically --> the bilirubin level reaches about 80 μmol/L

• Permanent damage --> Kernicterus

- Athetoid cerebral palsy - developmental delay - hearing deficit - dental dysplasia - Permanent upward gaze (Parinaud’s sign)

Complications

Complications

• Reversible damage --> Acute bilirubin encephalopathy

• Initial signs include: - lethargy - hypotonia - poor suck, progressing to - hypertonia (opisthotonos&retrocollis) - High pitched cry

Treatment

• Phototherapy Complications: Loose stools Erythematous macular rash Overheating --> leading to dehydration Bronze baby syndrome

• Exchange transfusion - no response with phototherapy - reaches the threshold of the transfusion

Take home message

• Up to date• Tom Lissauer, Graham Clayden. Illustrated

textbook of Pediatrics, 4th edition • NELSON, Essentials of pediatrics • Queensland Maternity and Neonatal Clinical

guideline • NICE guidelines for neonatal jaundice

Literatures

Questions !!