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Physiological Jaundice

Physiological Jaundice is a yellow discolouration of the skin, sclera and mucous membrane due to an increase in the serum bilirubin level. Peaks 48-72 hours disappears by 1 week does not present before 24 hours. Preterm infants - 80% 30 - 50 % of term infants in first week of life 10% will require phototherapy.

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Noor Shahirah Ayub
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3K views23 pages

Physiological Jaundice

Physiological Jaundice is a yellow discolouration of the skin, sclera and mucous membrane due to an increase in the serum bilirubin level. Peaks 48-72 hours disappears by 1 week does not present before 24 hours. Preterm infants - 80% 30 - 50 % of term infants in first week of life 10% will require phototherapy.

Uploaded by

Noor Shahirah Ayub
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PHYSIOLOGICAL JAUNDICE

Learning Outcomes:

The students will at the end of the session be


able to:
a) Understand the aetiology of physiological
jaundice
b) Appreciate the dangers associated with
jaundice

c) Evaluate the management & treatment


for neonatal jaundice

What is Jaundice?
A yellow discolouration of the skin, sclera and
mucous membrane due to an increase in the serum
bilirubin level. This becomes clinically evident when
serum bilirubin reaches about
80-100 mol/l.
Physiological jaundice usually
peaks 48-72 hours

disappears by 1 week
does not present before 24 hours

Incidence:
Preterm infants 80%
30 50 % of term infants in first week of
life

10% will require phototherapy

Aetiology of Physiological Jaundice


Hb in neonate =18-19g/dl and in adult =11-14g/dl
Breakdown of excess RBCs (Haemoglobin is a
constituent of RBC)
Hb broken into:
(i) globin - a protein that is conserved and utilised
(ii) haem - cannot be used
degraded and excreted
Bilirubin is a product of this degradation
It causes yellow staining of the tissues

The bilirubin first formed is UNCONJUGATED & FAT SOLUBLE.


It cannot be excreted in bile or urine

Unconjugated Bilirubin
- travels in plasma, bound to albumin.
- enters the liver cells with the aid of Y & Z carrier proteins

- becomes conjugated with glucoronic acid


The reaction is catalysed by an enzyme Glucuronyl
Transferase

Hypoxia or hypothermia may compromise


bilirubin conjugation

Conjugated Bilirubin is water soluble

It is excreted through the biliary tree into the gut.

Conjugated bilirubin is further catabolised by intestinal flora into:


i.

urobilinogen

ii. stercobilin

It forms a major component of bile in faeces.


(This gives the characteristic orange colour to faeces.)

A small amount is passed in the urine

Conjugated Bilirubin is unstable


Why?
Due to :

1) the relatively alkaline environment of the duodenum &


jejunum
2) specific enzymes eg beta glucuronidase
Converts back into unconjugated bilirubin.

When deconjugated in the intestine:

the bilirubin is absorbed across the intestinal mucosa and


returned to the circulation and the portal venous system
CONJUGATION HAS TO TAKE PLACE ALL OVER
AGAIN

Physiological Factors Associated with Physiological


Jaundice

1) Hb level is higher than required


2) RBC have shorter life
3) Hepatic Immaturity

- reduced glucuronyl transferase activity


- reduced active uptake of UB
- reduced intracellular transport system
- reduced active secretion of CB
- large enterohepatic circulation of bilirubin to add to
the load of UB in the hepatocyte

Other Factors That Can Contribute To


Physiological Jaundice
Drugs eg antibiotics (penicillin)
Bruises
Caput
Cephalhaematoma

Hypoxia /asphyxia
Hypoglycaemia
Hypothermia

INVESTIGATIONS

Assessment of skin and sclera colour


Clinical history of mother/family
History of labour ?bruising / cephal haematoma /birth
trauma
Blood group & rhesus factor
Feeding pattern
Infection
G6PD

Drugs
Serum bilirubin ? conjugated/unconjugated
(Icterometer)

Hb
Reticulocyte count ( raised levels in cases of
haemolysis)

Danger of Jaundice - KERNICTERUS!!!

Care of Baby

Early feeding/ Nutrition/ Hydration


Increase frequency of breast feeding
Neutral thermal environment

Prevent hypoglycaemia and hypoxia


Avoid constipation

May require Phototherapy


Conventional or Fibro-optic blankets

- converts fat soluble to water soluble bilirubin


? When to commence phototherapy

Management of Jaundice
Feeding
SBR levels- invasive!! (? icterometer)

- pain
- infection
Phototherapy

- to maintain levels below 340 mmols/l


(others argue 500mmol/l)

Care of Baby Requiring Phototherapy


Hygiene (sore buttocks)
Eye pads
Serum bilirubin levels
Parent infant attachment

Problems with phototherapy


Hypothermia
Hyperthermia
Rashes

Gastro-intestinal upset
Dehydration
Isolation

Interfere with breastfeeding

Other Types of Jaundice:


1.Haemolytic
- ABO Incompatability

- Rhesus Incompatability
- Polycythaemia
- Extravasation of blood
- Septicaemia
- Glucose 6-Phosphate Dehydrogenase Deficiency
- Spherocytosis

2. Reduced Albumin Binding Capacity


- drugs, hypoxia, hypothermia, acidosis,
hypoalbuminaemia

3. Defective Conjugation
- infection, breast feeding, inborn errors of metabolism

4. Breast milk jaundice


- progressive increase in bilirubin from day 4, peaks at
10-15 days of life

5. Obstructive Jaundice
- obstruction to the flow of bile
- bilirubin is conjugated normally, but become
reabsorbed into the blood
- water soluble, therefore circulates to kidneys
colouring urine dark yellowish brown
- stools remain pale
** no risk of kernicterus

References

Al-Alaiyan (1996) Fiberoptic, conventional and combination


phototherapy for treatment of nonhaemolytic hyperbilirubinemia in
neonates http://www.kfshrc.edu.sa/annals/166/96-036.html Date
accessed 20/10/2000
Blackburn (1995) Hyperbilinemia & Neonatal Jaundice. Neonatal
Network (October) 14: 7 15
Coe L (1999) Pathology & physiology of neonatal jaundice BJM April
p 240-243
College of Family Physicians of Canada (1999) Approach to the
management of hyperbilirubinemia in term newborn infants paeditrics
& Child Health 4(2); 161-164
http://www.cps.ca/english/statements/FN/fn98-02.htm date accessed
20/10/00

Hey (1995) Phototherapy: fresh light on a murky subject.Midirs


Midwifery Digest (Sept ) 5:3; 256 Hey (1995)Neonatal jaundice-how much do we really know?
Midirs Midwifery Digest (March) 5: 1;4 Robertson (1993) Neonatal jaundice. Mechanisms & diagnosis.
Modern Midwife. Sept/Oct: p28

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