NEONATAL NEONATAL JAUNDICE JAUNDICE Dr. Leow Poy Lee Pakar Pediatrik Hospital Kuala Pilah
NEONATAL JAUNDICE • Common phenomenon in neonates (Incidence up to 40-50% Asians, 10% Caucasians – S’pore study) • Increased indirect bilirubin (> common) and/or direct bilirubin • C/b excessive RBC destruction or reduced ability of liver to excrete
Aetiology of NNJ 1. Physiological jaundice 2. Haemolytic : ABO incomp, Rh incomp, G6PD def, pyruvate kinase def, Hereditary spherocytosis/elliptocytocytosis 3. Polycythaemia, Haematoma, Bruises 4. Infection: Septicaemia, UTI, Intrauterine infn 5. Metabolic disease: Hypothyroidism, Galactosaemia, L-1antitrypsin def., Crigler- Najjar Syn, Dubin-Johnson and Rotor syn 6. Obstructive jaundice: Biliary atresia, choledochal cyst, Neonatal hepatitis syn. 7. Breastmilk jaundice
Physiological Jaundice Common in first week of life ( start D2-3, peak at D4-5, resolve by D7-8) Due to: • Increased bilirubin load (larger RBC volume,shorter RBCs life span,increased enterohepatic circulation) • Reduced uptake of bilirubin by the liver • Reduced conjugation TSB usu. < 12-15mg% Aggravated by poor caloric intake, dehydration, GIT stasis, prematurity
Haemolytic Jaundice Early-onset jaundice (within 24 hrs of life), rapid rise. Rhesus incomp . • 15% Caucasian women are Rhesus negative, Indians 5%, Chinese and Malay 1% • Sensitised by Rh positive blood (previous pregnancy,bld transfusion.) • First baby usu. alright, subsequent ones increased severity. May result in Hydrops foetalis.
- Fall '15