Common Neonatal Presentation: Jaundice

Common Neonatal Presentation

• Neonatal jaundice is characterized by hyperbilirubinemia, an excess of bilirubin in blood serum.
• Unconjugated bilirubin results from the breakdown of hemoglobin; it is lipid-soluble and capable of crossing the blood-brain barrier.
• Kernicterus refers to bilirubin-induced brain damage, leading to cerebral palsy; symptoms include lethargy, poor feeding, abnormal tone, a high-pitched cry, and irritability.

Physiological Jaundice

• Approximately 60% of healthy newborns exhibit jaundice in the first week of life.
• Diagnosis is considered if jaundice appears after 24-36 hours of age, should worsen with a rate of rise >5 μmol/L/hr, and usually resolves by 14 days.

Investigations for Jaundice

• Serum bilirubin levels must be checked when transcutaneous bilirubin (TcB) reaches critical thresholds.
• A complete blood count (CBC), reticulocyte count, and direct Coombs test assess for hemolysis.
• Additional tests like urea, electrolytes, creatinine, and serum albumin facilitate dehydration management.

Phototherapy Treatment

• Phototherapy involves exposing a baby’s skin to blue fluorescent lights (430-490nm) to convert bilirubin into a more excretable form.
• To enhance treatment, provide maximum skin exposure to the light settings, ensuring the baby is adequately hydrated.
• Monitor urine and stool color and check skin integrity throughout treatment.

Types of Phototherapy

• Single Blue Phototherapy: One plane of the body is treated by turning the baby every 2-3 hours, ensuring warmth, and monitoring vital signs.
• Double Blue Phototherapy: Exposes both front and back simultaneously; indicated if serum bilirubin levels exceed safe limits or if bilirubin rise is rapid, although it may cause temperature instability and increased water loss.

Feeding During Phototherapy

• Feeding should continue unless exchange transfusion is necessary; increase feeds by at least 10% of expected intake.
• Babies can be briefly removed from phototherapy for feeding if bilirubin levels are manageable.
• Educate caregivers about signs of dehydration and the importance of follow-up appointments, especially for early discharges.

Risk Factors for Jaundice

• Low Risk: Typically, physiological jaundice in healthy infants.
• High Risk: Factors include preterm birth, hemolytic conditions, sepsis, and dehydration.

Medical and Surgical Causes

• Potential infections include upper respiratory infections, gastroenteritis, urinary tract infections, and meningitis.
• Surgical issues could entail hernias, trauma, or intestinal blockages.
• Monitor for signs of non-accidental injury (NAI), abnormal laboratory findings, and parental stress that may complicate the infant's care.

Explore the critical aspects of neonatal jaundice through this quiz. Learn about hyperbilirubinemia, its assessment, and the principles of phototherapy in managing this condition. Enhance your understanding of how excess bilirubin can impact neonatal health.