Neonatal Jaundice &

Convulsions
Objectives
• Discuss identification and treatment of
neonatal jaundice
• Review treatment of neonatal convulsions
Neonatal Jaundice
• More than 50% of normal
newborns and 80% of
preterm infants have some
jaundice.
• Jaundice may be normal or
abnormal depending on:
• Day of Presentation
• Gestation of the Newborn
• Severity of the Level of
Jaundice
• Presence of Associated
Symptoms
When to treat Jaundice?
• Day 1 Jaundice:
• Investigate if possible (Hb, DCT)
• Refer for possible exchange transfusion
• Start phototherapy immediately even if jaundice mild
• Day 2+ – Investigate and treat based on tables
and:
• Gestation,
• Post-natal age,
• Bilirubin Level
• Day 2+ and unable to measure bilirubin?
• Treat based on clinical signs
• Start treatment early in preterm babies
Effectiveness of Phototherapy (1)

• Special Blue lights >

Normal Fluorescent
lights
• Effectiveness depends
on total power – use
high Watt strip lights (40
– 60W) in sets
• Keep bulbs cool – allow
air to flow.
• Check bulbs not too old.
Effectiveness of Phototherapy (2)

• Depends on distance from the

lights, recommend 30 cm
• Increase distance to 60cm
you decrease power by 50%
• Check baby’s temperature to
avoid overheating
• Depends on surface area
exposed to light
• Do not cover with a blanket

• Only cover eyes

Effectiveness of Phototherapy (3)

• If there are neurological signs

exchange is needed
• Good phototherapy can
decrease bilirubin >20% in 24
hours
• Baby’s can come out to be
breast fed and cuddled
• Extra fluids are not required
 Treatment of Convulsions (Birth Asphyxia)

• Diazepam is Toxic level

dangerous in babies
< 1 month
• First line treatment is
Phenobarbitone 20
mg/kg im Effective level

• Maintenance usually
5mg/kg im, oral or ngt 20mg/kg 5mg/kg 5mg/kg
every 24 hours.
Treatment for a fitting
baby weighing 3.1kg?

• ABCD Evaluation

• Check for Hypoglycemia – If present treat with 2 ml/kg of 10%

Dextrose (6mls)
• Start phenobarbitone: 60 mg im
• NOT as an iv bolus.

• If the child continues to convulse after 30 minutes a further 5 -

10 mg / kg im can be given BUT continuous monitoring for
respiratory depression is required.
• Then no more phenobarbitone for 24 hours unless directed by a
consultant.
Anti-pyretics?
• Febrile fits occur at ages ≥ 6 months
• Fever can be effectively treated by removing
covers / clothes in the first weeks of life.
• So fever should first be investigated and treated
with simple measures.
• Anti-pyretics may have side effects and there is
no routine indication for drugs to reduce
temperature
• Use them when simple measures fail

• Pain is a separate consideration

QUESTIONS?
Summary

• Neonates with moderate to severe jaundice

should receive effective phototherapy and/or
exchange transfusion

• Treatment of neonatal convulsions involves

rapid ABCD assessment and use of
appropriate anticonvulsants