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Neonatal Jaundice

Neonatal Jaundice. Carrie Phillipi, MD, PhD. Newborn with Jaundice. Neonatal Jaundice Definitions. Physiologic Pathologic Indirect (unconjugated) Direct (conjugated) Breast feeding jaundice Breast milk jaundice. Production of Bilirubin. Conjugation of Bilirubin.

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Neonatal Jaundice

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  1. Neonatal Jaundice Carrie Phillipi, MD, PhD

  2. Newborn with Jaundice

  3. Neonatal Jaundice Definitions • Physiologic • Pathologic • Indirect (unconjugated) • Direct (conjugated) • Breast feeding jaundice • Breast milk jaundice

  4. Production of Bilirubin

  5. Conjugation of Bilirubin

  6. Problems at the level of the RBC • Hemolysis (ABO, Rh, minor antigens) • Hemolysis (Enzyme Deficits--G6PD deficiency) • Bruising • Cephalohematoma • Increased Load (polycytemia) • Membrane Defects

  7. Direct and Indirect Coombs

  8. Problems at the level of the LIVER • Sluggish enzyme (UGT 1A1) • Crigler-Najjar (rare) • Gilbert’s (rare) • Direct hyperbilirubinemia (always pathologic)

  9. Problems at the level of the GUT • Poor feeding • Obstruction • Infant of a diabetic mother The entero-hepatic circulation kicks in!

  10. Generic Problems • Prematurity • Serious Infections • Sepsis • Hypoalbuminemia

  11. Jaundice on at 96 hours • A term baby is noted to be jaundiced to the hips at 96 hours of life. Mother is AB+/Ab-, her milk is in and baby is feeding well with transitional stools. • What is your next step?

  12. Hyperbilirubinemia—risk stratification

  13. Exclusive Breastfeeding Risk factors for jaundice Jaundice in the first 24 hours East Asian Race Cehalohematoma Blood Group Incompatibility or known Hemolytic Disease (G6PD deficiency) Bruising Previous sibling who received phototherapy

  14. Guidelines for Phototherapy

  15. Kernicterus

  16. Jaundice at 12 hours • A term baby born by SVD with apgars of 8,9 is noted to have jaundice to the chest at 12 hours of life. Mother is O+/Ab-. Baby is vigorous and well-appearing. • What is your next step?

  17. Phototherapy

  18. Transcutaneous Bilirubinometer

  19. Jaundice at 72 hours • Well-appearing near term (37 week) infant born to O+/Ab- mother is noted to be jaundiced to the hips at 72 hours. • What is your next step?

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