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Jaundice
Yellowish discoloration of
the skin, sclerae, and
mucous membranes due
to accumulation of
bilirubin pigment
Hyperbilirubinemia
Unconjugated bilirubin
(Normal: 0.2 to 1.4 mg/dL or 0-5 umol/L)
- indirect bilirubin
- nonpolar
- lipid soluble (indirect reacting)
Conjugated bilirubin
(Normal: 0.1 to 0.4 mg/dL or 0-12 umol/L)
- direct bilirubin
- polar
- water soluble (direct reacting)
Hyperbilirubinemia
Incidence
Term 60%
Preterm 80%
Bilirubin (bile pigment)
- end product of hemoglobin metabolism that is
excreted in bile.
- Neonates
75% - from catabolism of circulating
RBC
25% - from ineffective erythropoeisis
(bone marrow)
- from turnover of heme proteins
and free heme (liver)
Uptake of bilirubin by Blood Bilirubin-Albumin
hepatocytes
(facilitated transport) conjugate
Liver
Bilirubin
Conjugation 2UDP-Diglucuronide
UDP-glucuronyl 2 UDP
transferase
Physiologic Jaundice
Non-physiologic Jaundice
Clinical Assessment of Jaundice
Manifested as yellowing of the:
Face ~5 mg/dl
Abdomen ~15mg/dl
Soles ~20 mg/dl
Deficiency of G6PD
A. Overproduction Hyperbilirubinemia
Blood Group Incompatibilities
Maternal-fetal or feto-fetal transfusions
Non Immune Hemolytic Anemias
Structurally Abnormal Red Cells
Extravascular Hemolysis
Non-physiologic Jaundice
B. Undersecretion Hyperbilirubinemia
Enzymatic Deficiency
Hormonal Suppression (Breastmilk Jaundice)
Inhibition of Conjugation
Hepatic Cell Injury Due to Infections
Substrate Deficiency (hypoglycemia)
Mechanical Obstruction
Over Production Bilirubinemia
Intrauterine Infections
Toxoplasmosis
Rubella Coombs test Coombs test
CMV positive negative
Herpes simplex Rh
Syphilis ABO
Biliary atresia Minor blood
Paucity of intrahepatic bile group
ducts Hematocrit
Giant cell hepatitis
Sepsis
Bile Plugs
Choledochal cyst
Cystic fibrosis
Galactosemia
Hematocrit
High
Twin-twin transfusion
Normal or low Maternal-fetal transfusion
Delayed cord clamping
Small for dates
Normal
Red cell morphology Extravascular blood
and reticulocyte count Cephalhematoma, bruising, other
hemorrhage
Increased Enterohepatic circulation
Breast feeding
Abnormal
Pyloric stenosis
Small or large bowel obstruction
Specific Non specific Swallowed blood
morphological abnormalities Metabolic-endocrine
abnormalities ABO Congenital glucuronyl transferase
Spherocytosis incompatibility deficiency
Elliptocytosis G6PD deficiency Breast milk jaundice
Stomatocytosis Pyruvate kinase Others: Infants of DM mother; inadequate
Pyknocytosis deficiency caloric intake
Alpha-thalassemia
DIC
Kernicterus
1. Photo-isomerization (reversible)
- toxic native unconjugated 4Z, 15Z-bilirubin is
converted into an unconjugated
configurational isomer 4Z,15E-bilirubin
-comprises about 20% of TSB in a baby under
phototherapy
2. Structural isomerization (irreversible)
-Bilirubin becomes Lumirubin
-cleared from the serum much more rapidly
Usually continued for 5 days, the time wherein
physiologic jaundice subsides.
- Babys eyes are shielded to avoid retinal
degeneration
Complications of phototherapy
loose stools
erythematous macular rash
purpuric rash
overheating
dehydration (increased insensible water loss,
diarrhea)
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