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Neonatal Jaundice Hyperbilirubinemia

Neonatal Jaundice Hyperbilirubinemia. Fred Hill, MA, RRT. Neonatal Jaundice. What is Bilirubin?. End product of catabolism of iron protoporphyrin (heme) Primarily from circulating hemoglobin 75% from erythrocytes 25% from heme in liver enzymes. Why in Newborns?.

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Neonatal Jaundice Hyperbilirubinemia

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  1. Neonatal JaundiceHyperbilirubinemia Fred Hill, MA, RRT

  2. Neonatal Jaundice

  3. What is Bilirubin? • End product of catabolism of iron protoporphyrin (heme) • Primarily from circulating hemoglobin • 75% from erythrocytes • 25% from heme in liver enzymes

  4. Why in Newborns? • Normal neonate produces ~ 6 to 8 mg/kg/day (2.5 X adult production) • Significant amounts of unconjugated bilirubin absorbed from the intestine • Decreased clearance of bilirubin from the plasma due to decrease levels of ligandin and uridine diphosphate glucuronosyl transferase (1% of activity found in adults) in the liver.

  5. Why in Newborns? • Premature neonates: born too soon and have extremely limited UDPGT (0.1% of adult activity at 30 weeks gestation). • Term and near-term infants: only about 5% have pathologic cause for jaundice. Usually occurs in 1st two weeks of life.

  6. Pathologic Causes of Jaundice • Maternofetal blood incompatabilities • Rh may cause severe hemolysis • ABO incompatibility usually not severe • Fetal or newborn hemorrhages • Sepsis (cause of hemolysis) • Infections may impair liver function • Biliary atresia

  7. Pathologic Causes of Jaundice Identified by: • early onset (within 24 hours of birth) • Unconjugated (indirect) bilirubin >13 mg/dl • Indirect levels rise by more than 5 mg/dl in a 24 hour period • Direct bilirubin >1.5 mg/dl • Persistent jaundice • >7 days in term newborn • >14 days in premature newborn

  8. Complications and Treatment Most serious complication is kernicterus (bilirubin pigment deposited in brain tissue) leading to neuronal injury. Treatment • Treat cause • Phototherapy (blue lights) • Exchange transfusion • Infusion of phenobarbital and albumin

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