neonatal jaundice

suspect pathological jaundice if:
1. Age of onset (<24H, >2 weeks)
2. level total bilirubin >257umol/L
3. increament of total bilirubin >85umol/L.day
4. any conjugated hyperbilirubinaemia
5. any hepatosplenomegaly

watch out total bilirubin level in preterm infant. lower treshold of jaundice indicatd as they are more susceptible to brain damage.

Age <24hours
unconjugated:
1. Rh incompatibility
   - hepatosplenomegaly
   - hydrops
   - anaemia
   - now  >Kell Duffy

2. ABO incompatible
   - less severe compare to Rh incompatibility
   - no hepatosplenomegaly
   - normally cause by IgG anti A haemolysin from blood group o mother <IgG nati B (normal person IgM antibody which dose not cross placenta)

3. G6PD
   - Glutathione deficiency
   - after taking certain drug

4. spherocyosis
   - detect from PBF

5. pyruvate kinase deficiency

Conjugated
1. congenital infection
  - TORCH
  - may have other s/s


2nd day till 2 week
1. physiological jaundice
2. breaast milk jaundice- advice continue breast feeding and hydration by breast milk
3. infection (UTI)
  - from poor fluid intake, haemolysis, poor hepatic function, increase enterohepatic circuation
4. bruises
5. polycythaemia
6. Crigler Najjar syn (glucoronyl transferase)

Prolong jaundice (>2 weeks)
unconjugated
1. breast milk jaundice

2. infection (UTI)

3. hypothyroidism
  - coarse facies, dry skin, hpotonia, poor feeding, constipation

conjugated (pale stool, dark urine)
1. biliary atresia>> ascending cholangitis

2. hepatitis

severity:
see the blanching level:
- nipple 100
- umbilicus 200
- thigh 300
- peripheral high

susceptible to damage from hyperbilirubinaemia:
1. preterm
2. hypoxia
3. hypothermia
4. serious illness

drug cause jaundice (displace bilirubin fr albumin)
sulphonamides
diazepam


management:
low level, counsel for hydration, sunlight exposure

pathological:
1. phototheraoy
   - must cover eye
   - sometimes can use double photo (fiberoptic blanket)
   - Complication: hypothermia (baby undress), affected normal nursing, if conjugated bilirubin might cause macular rash and bronze

2. exchange transfusion
   - indicated if serum albumin low, haemolysis, cannot lower via phototx
   - can give via umbilical venous catheter (withdraw 10-20ml aliquots and replace with donor blood)- can cause complications
   - use peripheral vein while extract blood from arterial line

3. IVIG for Rh incompatibility

4.IV albumin can be given in preterm infant.

Placentation and Pre-eclampsia

normal placentation:
blood flow 1st T-500ml/min, term-600ml/min
anatomical changes of muscular spiral vessel to flaccid vessel
1-12 weeks:
Invasion by the trophoblastic and fibrinoid tissue.
trophoblastic plague in the lumen of spiral arteries is release thus sudden increase of blood flow towards intervillous space.
12-20weeks:
invasion of trophoblastic tissue to intramyometrial segment of spiral arteries causing further reducein resistance of blood flow to placenta
(MID TRIMESTER FALL IN MOTHER BP)
Called FLACCID TRANSFORMATION OF SPIRAL ARTERY

• lack smooth muscle so less response to vasoactive components
• increase perfussion