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.
