Neonatal Jaundice

A symptom or stage of illness in which bilirubin is increased in blood leading to yellowish discoloration of skin, mucous membrane, sclera and nail.

Types of Jaundice:

1. Physiological Jaundice: It may develop in first 2-3 days of life and may

    subside in 6-7 days.

2. Pathological Jaundice: If there is abnormal elevation of unconjugated

     bilirubin.

Causes of Jaundice:

Physiological Jaundice:

1. It is caused by impairment in the removal of bilirubin.

2. Breakdowen of foetal red blood cells.

3. Increased enteropathic circulation of bilirubin.

4. Hepatic immaturity.

Pathological Jaundice:

1. ABO+RH incompatibility.

2. Hepatobiliary infection.

3. Polycythemia.

4. Hepatitis (due to congenital infection).

5. Breast milk Jaundice.

6. Hypoxia and sepsis.

7. Biliary atresia.

8. Congenital hypoplastic anaemia.

9. Haemolytic disorder.

10. Hypothyroidism.

Sequenlae of unconjugated hyperbilirubinaemia:

1. Transient encephalopathy

2. Kernicterus

Investigations:

In early phase:

1. Serum bilirubin ( direct+ Indirect)

2. Blood grouping ( ABO, RH)

3. Coombs test

4. Haematocrit

5. Reticulocyte count

6. Septic screening.

Late and prolong Jaundice investigations:

1. Liver function test (LFT).

2. Serum albumin and Ph.

3. Thyroid function test.

4. USG of hepatobiliary system.

5. Examination of bruishing.

Treatment of Jaundice:

1. Phototherapy

2. Exchange transfusion

Management of Jaundice observation:

Observation:

·       Vital sign

·       Exchange transfusion set

·       Mask for eye shield(screen to cover light, napkin)

·       Observe the yellowish discolouration of skin, sclera

·       Skin for redness, eruption

·       Dehydration

·       Stool and urine colour.

·       Sucking reflex.

·       Activitiy: Lethargy

·       Intra venous fluid

·       Blood volumes ( in case of exchange transfusion).

·       Watch for sign of respiratory distress.

·       Watch for umbilical site for evidence of bleeding or infection.

Action:

·       To control and regulate the body temperature.

·       Shield the eye with eye mask.

·       Cover the male genital part with napkin.

·       Intake output charting.

·       Exclusive breast feeding.

·       Intravenous fluid for fluid and electrolyte balance to prevent dehydration.

·       Give glucose water if the child can.

·       Explanation of procedure and disease condition to the patient family which reduces the tension.

·       To keep the skin clean.

·       If respiratory distress develop especially (in exchange transfusion), infusion rate should be stopped and managed immediately.

·       In cases of umbilical infection and bleeding maintain a sterile dressing.

·       Keep the accurate record of treatment and procedure.

Health Education:

·       Give the detail explanation about patient disease condition and the procedure to the family.

·       Provide psychological support to the family as it helps to allay anxiety and tension.

·       Exposure to the sunlight in the morning.

·       Give glucose water to the baby if possible.

·       Do not apply oil to the baby.

·       Exclusive breast feeding.

·       Maintenance of hygiene.

·       Frequent position change.

·       Encourage high carbohydrate diet and low protein diet.