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NEONATAL JAUNDICE

NEONATAL JAUNDICE. BY DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER / CONSULTANT PAEDIATRICIAN H.O.D, DEPT OF PAEDIATRICS, DELSU & DELSUTH . MEDICAL DIRECTOR

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NEONATAL JAUNDICE

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  1. NEONATAL JAUNDICE BY DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER / CONSULTANT PAEDIATRICIAN H.O.D, DEPT OF PAEDIATRICS, DELSU & DELSUTH. MEDICAL DIRECTOR RAPHA SPECIALIST CHILDREN & GENERAL CLINIC, 85 AIRPORT ROAD, EFFURUN.

  2. PRE - TEST • What the causes jaundice in neonates? • How is jaundice diagnosed? • What is physiologic jaundice? • Which of the following is useful for Rx : • Early morning sunlight (b) Glucose + Ampiclox (c ) Phenobarbitone

  3. LEARNING OBJECTIVES • DEFINE JAUNDICE • PATHOPHYSIOLOGY OF JAUNDICE • DANGER OF JAUNDICE • DEBUNKING WRONG TREATMENTS • EMPHASIZING PROMPT & EFFECTIVE TREATMENT

  4. DEFINITION PREVALENCE BURDEN OF THE DISEASE INTRODUCTION

  5. BILIRUBIN METABOLISM • SOURCES OF BILIRUBIN • HEMOLYSIS • BILIRUBIN BINDING TO ALBUMIN • LIVER UPTAKE • BINDING TO LIGADIN Y & Z • CONJUGATION WITH UDPGT • EXCRETION INTO BILE • ENTEROHEPATIC CIRCULATION

  6. PHYSIOLOGIC JAUNDICE • DEFINITION • CAUSES • - RBC VOL ,RBC SURVIVAL,ELB,EHC • -DEFECTIVE UPTAKE • -DEFECTIVE CONJUGATION • -REDUCED EXCRETION • RATE OF RISE AND PEAK

  7. PATHOLOGIC JAUNDICE • DEFINITION • CAUSES • -POLYCYTHAEMIA • -HEMOLYSIS • -BILIRUBIN DISPLACEMENT • -HEPATOBILIARY DISEASES • RATE OF RISE AND PEAK

  8. BILIRUBIN TOXICITY • PATHOLOGY: UNCOUPLING OF OXIDATIVE PHOSPHORILATION, NEURONAL CELL DEATH • WORSE HIT:BASALGANGLIA,GLOBUS PALLIDUS,PUTAMEN,CAUDATE NUCLEI • + CH, BULBAR & CEREBELLAR NUCLEI

  9. CLINICAL STAGING 1.POOR MORO,HYPOTONIA,LETHARGY POOR FEEDING, HIGH PITCH CRY 2.OPISTHOTONUS,HYPERTONIA,FEVER SEIZURES,ROWING “BICYCLING” PARALYSIS OF UPWARD GAZE 3.APPARENT RECOVERY 4.LATE SEQUELAE: SPASTICITY,ATHETOSIS COMPLETE OR PARTIAL DEAFNESS, CP, MR

  10. CLINICAL EVALUATION • VISUAL ESTIMATION(ROUGH GUIDE) • SB (TOTAL & CONJUGATED) • PCV & COOMBS • CONJ BIL < 2mg% VERSUS > 2mg % • PCV HIGH VS NORMAL OR LOW • RETIC NORMAL VS ABNORMAL

  11. TREATMENT • PHOTOTHERAPY:INDICATIONS,MOA LIGHT SOURCE, TECHNIQUE, PHOTO BLANKET • EBT; INDICATIONS,MOA, TECHNIQUE • PHENOBARBITONE: MOA, DEMERITS CONTEMPORARY INDICATIONS • ACTIVATED CHARCOL • TIN PROTOPORPHYRIN

  12. CONCLUSION • NO ROASTING OF BABY IN THE SUN • NO AMPICLOX AND GLUCOSE • NO DELAY TO REFER BABY • STOP CEREBRAL PALSY PLEASE!!!!!

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