Neonatal jaundice

Internship year
2023-2024
Pediatric area
Duration from
1/4/2024 to 30/6/2024
Group:7A
Under supervition
Dr/ Amira mohamed
Dr/ Aya shaker
Prepared by Group7
• Eman Mahmoud Abdallah
• Aya Elsayed AbdElstar
• Fatma kamel mohamed
• Samar medhat risk
• Shimaa Elsayed Mahmoud
• Sohila Ebrahim Nematallah
• Amal Osman Hamdy
• Mohamed Samy Elsayed
• Mohamed Salah fahmy
• Mohamed Antar Shushan
 Neonatal jaundice

• Introduction
• Types
• Causes
• Sign and symptoms
• Risk factors
• Complications
• Diagnosis
• Treatment
• Prevention
• References
INTRODUCTION
Neonatal jaundice
yellowish discoloration of the eyes and skin in a newborn
baby due to high bilirubin levels. Newborn jaundice occurs
when a baby has a high level of bilirubin in the blood.
Bilirubin is a yellow substance that the body creates when
it replaces old red blood cells. The liver helps break down
the substance so it can be removed from the body in the
stool. In the majority of cases, the jaundice is transient,
usually resolving by the end of the first postnatal week, and
serum total bilirubin (STB) concentrations are not harmful.
In some infants, severe hyperbilirubinemia may develop
with the potential for acute bilirubin encephalopathy. Some
of these cases may progress to the chronic form of cerebral
palsy known as kernicterus. In recent years it has become
apparent that the modulation of bilirubin metabolism and
the determination of whether STB concentrations remain
within the physiologic range or increase to potentially
harmful concentrations lie within genetic control.

Types
There are a few different types of jaundice in new-borns

Physiological jaundice
The most common type of jaundice in newborns is
physiological jaundice. This type of jaundice is normal.
Physiological jaundice develops in most newborns by their
second or third day of life. After your baby’s liver develops,
it will start to get rid of excess bilirubin. Physiological
jaundice usually isn’t serious and goes away on its own
within two weeks

Breastfeeding jaundice
Jaundice is more common in breastfed babies than
formula-fed babies. Breast feeding jaundice frequently
occurs during your baby first week of life. It happens when
your baby doesn’t get enough breast milk. It can occur due
to nursing difficulties or because your milk hasn’t come in
yet. Breastfeeding jaundice may take longer to go away

Breast milk jaundice

Breast milk jaundice is different than breastfeeding
jaundice. Substances in your breast milk can affect how
your baby’s liver breaks down bilirubin. This can cause a
bilirubin build up. Breast milk jaundice may appear after
your baby’s first week of life and may take a month or more
to disappear. other types of jaundice can occur if your baby
has an unrelated medication
Causes

The yellow appearance comes from the accumulation of a

yellow pigment called bilirubin in the skin. Right after birth,
the infant body has to break down the red blood cells used
while in the womb and make new ones now that the baby
breathes the ambient air. The red color of the blood comes
from a protein called hemoglobin, which carries the
oxygen. As cells are being broken down, the hemoglobin
gets modified in the liver and becomes bilirubin. Because
the infant’s liver is so young and immature, it cannot keep
up with all the produced bilirubin, which then leaks into the
blood stream and settles in the skin.

Risk Factors

1. Low birth weight: premature and small for dates.

2. Breast-fed babies.
3. A previous sibling with neonatal jaundice requiring
phototherapy.
4. Visible jaundice in the first 24 hours.
5. Infants of mothers who have diabetes.
6. Male infants.
7. East Asians.
8. Populations living at high altitudes
Symptoms
The first symptom is yellow appearance of the skin
and the eyes. The infant’s skin may appear yellow as
early as the 1st or 2nd day of life. The jaundice starts
around the head and the face then progresses to the
shoulders, arms and the rest of the body including the
legs and feet. The appearance may become more
yellow when the baby is 3 to 4 days old and then
slowly gets better. This is called “physiologic” or
normal neonatal jaundice. Most infants have this
pattern so no testing is needed.
At times, the yellow appearance may occur earlier
(shortly after birth), last longer than 5-6 days or may
be much more pronounced. A consultation with your
health care provider is then needed to determine if
testing is indicated.
Along with the skin becoming more yellow, the color of
the baby’s urine can change from very light yellow or
very dark brown. In the same manner, the color of the
baby’s stool can vary from a yellow mustard color
(normal) to light beige. These 2 color changes in the
urine or the stool can indicate that the jaundice is due
to different pigments. Although very rare in the first
 days of life, the presence of a very dark urine or light
beige stool should be evaluated by a doctor
immediately.

Complications
High levels of bilirubin that cause severe jaundice can
result in serious complications if not treated.
Acute bilirubin encephalopathy
Bilirubin is toxic to cells of the brain. If a baby has severe
jaundice, there's a risk of bilirubin passing into the brain, a
condition called acute bilirubin encephalopathy. Prompt
treatment may prevent significant lasting damage.

Signs of acute bilirubin encephalopathy in a baby with

jaundice include:

• Listlessness
• Difficulty waking
• High-pitched crying
• Poor sucking or feeding
• Backward arching of the neck and body
• Fever

Kernicterus
Kernicterus is the syndrome that occurs if acute bilirubin
encephalopathy causes permanent damage to the brain.
Kernicterus may result in:
 • Involuntary and uncontrolled movements (athetoid
cerebral palsy)
• Permanent upward gaze
• Hearing loss
• Improper development of tooth enamel

Diagnosis
Your doctor will likely diagnose infant jaundice on the
basis of your baby's appearance. However, it's still
necessary to measure the level of bilirubin in your baby's
blood. The level of bilirubin (severity of jaundice) will
determine the course of treatment. Tests to detect
jaundice and measure bilirubin include:

• A physical exam
• A laboratory test of a sample of your baby's blood
• A skin test with a device called a transcutaneous
bilirubinometer, which measures the reflection of a
special light shone through the skin
Your doctor may order additional blood tests or urine tests
if there's evidence that your baby's jaundice is caused by
an underlying disorder.
Treatment

Most babies with jaundice don’t need treatment. If your

baby has mild jaundice, her provider may recommend that
you breastfeed your baby more often so to produce more
bowel movements. This helps to get rid of bilirubin.
Jaundice usually clears up within 2 weeks in formula-fed
babies. It may last for more than 2 to 3 weeks in breastfed
babies. If your baby’s jaundice lasts more than 3 weeks,
talk to your baby’s health care provider.
Babies with more severe jaundice may need treatment
including:
• Phototherapy treatment (also called light therapy
or bili lights).
This is when your baby is placed under special lights
that help your baby’s body change bilirubin into a form
that can exit the body in urine. While your baby is
under the lights, they wear just a diaper and shields
over the eyes. Some babies can lie on a light therapy
blanket (also called a fiberoptic blanket) that has tiny
bright lights in it. You may use the blanket in place of,
or along with, the overhead lights. If you can’t afford to
have your baby treated with the special lights or
blanket, your doctor may use indirect (filtered)
sunlight to treat your baby’s jaundice. This kind of
sunlight removes the rays that could burn your baby’s
skin, so it is safer than direct sunlight. Phototherapy
 can be done in the hospital or at home, and it’s safe
for your baby.
• Intravenous immunoglobulin (also called IVIg).
If you and your baby have different blood types, your
baby may get immunoglobulin (a blood protein)
through a needle into a vein. This can help treat the
jaundice so that your baby is less likely to need an
exchange transfusion.
• Exchange transfusion.
If phototherapy doesn’t work and your baby’s bilirubin
levels are still very high, your baby may need a
special type of blood transfusion called an exchange
transfusion. An exchange transfusion gets rid of
bilirubin by replacing your baby’s blood with fresh
blood in small amounts. This type of therapy is very
expensive and is only used when a baby who has
complications like CBE.
Prevention
The best preventive of infant jaundice is adequate feeding.
Breast-fed infants should have eight to 12 feedings a day
for the first several days of life. Formula-fed infants usually
should have 1 to 2 ounces (about 30 to 60 milliliters) of
formula every two to three hours for the first week.
Nursing care plan
• Bilirubin level monitoring.
Regularly monitoring the bilirubin levels in the
patient’s blood to assess the severity of
hyperbilirubinemia.
• Identification of underlying caus.

Investigating and identifying the underlying

cause of hyperbilirubinemia to guide treatment
decisions.
• Phototherapy.

Initiating and managing phototherapy to help

break down bilirubin and reduce its levels in the
blood.
• Blood transfusion.

Considering blood transfusion in severe cases of

hyperbilirubinemia to remove excess bilirubin and
provide additional red blood cells.
• Neonatal assessment.

Conducting a thorough neonatal assessment to

evaluate the overall health and identify any
additional concerns associated with
hyperbilirubinemia.
• Parent education.

Educating parents about the causes,

management, and signs of worsening
 hyperbilirubinemia, as well as the importance of
follow-up care.
• Liver function evaluation. Assessing liver
function to determine if there are any underlying
liver disorders contributing to hyperbilirubinemia.
• Coordinating with pediatric specialists.
Collaborating with pediatricians and specialists to
ensure comprehensive care and appropriate
management of hyperbilirubinemia.
• Support for breastfeeding.
Providing guidance and support to breastfeeding
mothers to optimize feeding practices, which can
help with bilirubin elimination.
• Long-term follow-up.
Planning for long-term follow-up to monitor the
resolution of hyperbilirubinemia and identify any
potential long-term problems.
References
• https://gi.org/topics/neonatal-jaundice/
• https://www.sciencedirect.com/topics/pharmacology-
toxicology-and-pharmaceutical-science/newborn-
jaundice
• https://www.mayoclinic.org/diseases-conditions/infant-
jaundice/symptoms-causes/syc-20373865