What is jaundice
Jaundice is apparent clinically when the level of bilirubin in the serum rises above
85μmol/l (5mg/dl). Physiological jaundice is a reflection of the bilirubin load to the liver,
rate of hepatic excretion (liver maturity) and ability of the serum binding protein to retain
the bilirubin within the plasma.
What can go wrong in jaundice
Elevated serum bilirubin can result in kernicterus, when unconjugated bilirubin is
deposited in the cell wall of neurons in basal ganglia, brain stem and cerebellum
resulting in cell death. Kernicterus is associated with a high mortality, and survivors
usually suffer sequelae like athetoid cerebral palsy, high frequency hearing loss,
paralysis of upward gaze and dental dysplasia. The factors influencing bilirubin toxicity
in the brain cells of the neonate are complex and incompletely understood. There is no
specific level of total serum bilirubin above which kernicterus can be predicted to
happen.
Causes of Jaundice Neonatal (NNJ)
The following are the recognised causes of NNJ:
• Haemolysis due to ABO or Rh isoimmunisation, G6PD deficiency,
microspherocytosis, drugs
• Physiological jaundice & idiopathic jaundice
• Polycythaemia
• Sepsis e.g. septicaemia, meningitis, urinary tract infection and intra-uterine
infection
• Breastfeeding and breastmilk jaundice
Factors affecting severity of NNJ
The following factors are said to affect the severity of jaundice
• Dehydration
• Large weight loss after birth
• Extravasation of blood, cephalohaematoma, contusion
• Swallowed maternal blood
• Infant of diabetic mother
• Acidosis
• Asphyxia
• Gastrointestinal tract obstruction: increase in enterohepatic circulation
HeRe ziddu
Jaundice is apparent clinically when the level of bilirubin in the serum rises above
85μmol/l (5mg/dl). Physiological jaundice is a reflection of the bilirubin load to the liver,
rate of hepatic excretion (liver maturity) and ability of the serum binding protein to retain
the bilirubin within the plasma.
What can go wrong in jaundice
Elevated serum bilirubin can result in kernicterus, when unconjugated bilirubin is
deposited in the cell wall of neurons in basal ganglia, brain stem and cerebellum
resulting in cell death. Kernicterus is associated with a high mortality, and survivors
usually suffer sequelae like athetoid cerebral palsy, high frequency hearing loss,
paralysis of upward gaze and dental dysplasia. The factors influencing bilirubin toxicity
in the brain cells of the neonate are complex and incompletely understood. There is no
specific level of total serum bilirubin above which kernicterus can be predicted to
happen.
Causes of Jaundice Neonatal (NNJ)
The following are the recognised causes of NNJ:
• Haemolysis due to ABO or Rh isoimmunisation, G6PD deficiency,
microspherocytosis, drugs
• Physiological jaundice & idiopathic jaundice
• Polycythaemia
• Sepsis e.g. septicaemia, meningitis, urinary tract infection and intra-uterine
infection
• Breastfeeding and breastmilk jaundice
Factors affecting severity of NNJ
The following factors are said to affect the severity of jaundice
• Dehydration
• Large weight loss after birth
• Extravasation of blood, cephalohaematoma, contusion
• Swallowed maternal blood
• Infant of diabetic mother
• Acidosis
• Asphyxia
• Gastrointestinal tract obstruction: increase in enterohepatic circulation
HeRe ziddu
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