Cause, Management and Treatment of Neonatal Jaundice
A neonatal jaundice may be defined as yellowish coloration of skin mucus membrane, cornea and other tissues due to increased concentration of bilirubin in body fluid / blood of a newborn infant. In neonates, more than 5mg/dl bilirubin level in blood is known as jaundice.
Count of bilirubin according to body color:
Head up to neck- 6mg/dl
Neck, chest up to umbilicus – 10 to 12mg/dl
Umbilicus up to thigh – 12 to 15mg/dl
Hands, legs and trunk – 15 to 18mg/dl
Whole body including palm and sole – 16 to 12mg/dl
Types of Neonatal Jaundice:
When jaundice appears on second or third day of birth of a newborn baby and disappears within 7 to 10 days is known as physiological jaundice. In case of premature babies, it may take a little later.
In a term infant the level of unconjugated bilirubin is generally 6 to 8mg/dl. It may rise up to 12mg/dl. In a preterm infant the level of unconjugated bilirubin may rise up to 12 to 15mg/dl in the first week.
When jaundice appears within 24 hours of birth of a baby, bilirubin level increasing at a rate of 5mg/dl per day and persists more than 2 weeks is known as pathological jaundice.
In a term baby, in pathological jaundice unconjugated bilirubin level is higher than 12mg/dl. Jaundice persisting more than 1 week. In a preterm baby unconjugated bilirubin level is higher than 15mg/dl. Jaundice persisting more than 2 weeks.
Causes of Jaundice:
- Physiological cause.
- Pathological: Pathological Jaundice are 15 types.
- Excessive destruction of RBCs due to Haemolytic disease of newborn.
- Rh incompatibility, ABO incompatibility.
- Congenital Spherocytosis
- Neonatal Septecaemia
- Cytomegalic Disease
- Biliary tract obstruction, viral hepatitis
- Breast milk jaundice (galactosaemia)
- Intrauterine infection (Toxoplasmosis), Syphilis.
- G-6 PD disease (Glucose – 6 Phosphate Dehydrogenase Deficiency)
- Intracranial haemorrhage.
- Drug therapy
Investigations to be done:
- Full blood count, TC, DC, WBC, platelet count.
- Bilirubin level –total, direct, indirect.
- Blood grouping & Rh typing
- Peripheral blood film
- Liver function test
- Coombs test-direct, indirect
Treatment of Neonatal jaundice:
- Estimation of serum bilirubin both conjugated and unconjugated.
- Phototherapy-If serum bilirubin is higher than 12mg/dl in term baby & higher than 10mg/dl in preterm baby.
- Drugs: Metaloporphyrins, phenobarbitone, Vitamin K 1mg I/M stat and daily for three days,Tab vitamin E 1/8th tab daily.
- Exchange transfusion: If unconjugated bilirubin level is higher than 18mg/dl in blood in term baby and higher than 15mg/dl in preterm baby.
- Treatment of causes of jaundice like Infection, hypoglycaemia, acidosis, anaemia.
Precautions during phototherapy:
- Frequently change the posture of the baby, approximately 2 hourly.
- Observe the infant for signs of dehydration.
- Maintain skin temperature.
- Cover infant`s eye to protect retina from damage due to light.
- Cover Genitalia in male child to protect testis from damage.
- Remove infant from light for 15 minutes for feeding, remove eye pads at this time.
- Dress the baby while remove from lights.
- Carefully examine eyes for irritation from eye patches.