By ULY CLINIC staff

 

Necrotizing Enterocolitis- NEC

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Introduction

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Neonatal jaundice is a yellowish discoloration of the sclera, skin and mucous membrane in a newborn baby due to high bilirubin levels. Other symptoms may include excess sleepiness or poor feeding, without immediate treatment it may bring complication including seizures, cerebral palsy and kernicterus.

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Research shows that between 60 to 80% of health infants are expected to present with jaundice of unkown causes

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Neonatal jaundice is divided into two types, physiological jaundice and pathological jaundice.

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1. Physiological Neonatal jaundice

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Physiologic jaundice is caused by a combination of increased bilirubin production secondary to accelerated destruction of erythrocytes, decreased excretory capacity secondary to low levels of ligandin in hepatocytes, and low activity of the bilirubin-conjugating enzyme uridine diphosphoglucuronyltransferase (UDPGT).

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Because of ↑ risk of bilibubin encephalopathy  “physiologic” jaundice is more difficult to define and jaundice should be followed closely.

 

Characteristics of Physiological jaundice

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In term Infants:

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• Jaundice in the first week of life.

• Total serum bilirubin peaks at age 3–5 d

• Mean peak total serum bilirubin is 6 mg/dL

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Preterm Infants:

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• Incidence of visible jaundice is much higher than in term infants

• Peak is later (5-7d).

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2. Pathological Neonatal jaundice

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Pathologic neonatal jaundice occurs when additional factors accompany the basic mechanisms described above. Somecauses include immune or nonimmune hemolytic anemia and polycythemia. Decreased clearance of bilirubin may play a role in breast feeding jaundice, breast milk jaundice, and in several metabolic and endocrine disorders.

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Characteristics of Pathological (non-physiological)

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• Jaundice started on the first day of life

• Jaundice lasting longer than 14 days in term infants, 21days in preterm infants

• Jaundice with fever

• Jaundice involving palms and soles of the baby

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Investigations

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• Serum Bilirubin Total and Direct

• FBP

• Blood group and Rh typing of baby and mother

• Coombs test

• VDRL

• G-6-P-D screening

• HIV screening

• Thyroid function tests

• Hepatitis screening and

• Liver function tests

• Abdominal ultrasound

 

Treatment

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• Phototherapy or Exchange transfusion depending on severity.

• Treat the underlying cause.

Phototherapy

Start phototherapy if total bilirubin > BWT x 100, or if bilirubin level is at the level of the nipple.

Note:

 

• The baby should only stop phototherapy after control level of bilirubin are reduced back to normal, and discharge 24 hours after being off phototherapy.

• Babies receiving phototherapy require an increased fluid volume of 10% of daily fluid requirements.
   

Indications for Phototherapy

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• Jaundice at the level of xiphoid sternum or more.

• Jaundice in preterm babies (<35 weeks).

• Jaundice on the palms and soles at any age.

• Jaundice due to haemolysis.