Question

What are the various causes, presentation, and modalities for treatment of neonatal jaundice?

Hint:

Timely diagnosis and treatment of neonatal jaundice are crucial to prevent complications such as kernicterus, especially in severe cases. Phototherapy is effective in most cases, but more aggressive treatment may be needed in severe forms.

Answer 1

Neonatal jaundice is a common condition in newborns, characterized by a yellowish discoloration of the skin and sclera due to an elevated level of bilirubin in the blood. It is important to identify the cause, monitor the severity, and provide appropriate treatment.
Step 1: Causes of Neonatal Jaundice:
1. Physiological Jaundice: - Occurs in healthy newborns, typically after the first 24 hours of life. It is due to the immaturity of the liver's ability to process bilirubin.
- Common in premature infants as they have lower hepatic enzyme activity and slower elimination of bilirubin. 2. Pathological Jaundice: - Hemolytic Disorders: Conditions like Rh incompatibility or ABO incompatibility can cause increased red blood cell breakdown, leading to higher bilirubin levels.
- G6PD Deficiency: Glucose-6-phosphate dehydrogenase deficiency can cause hemolysis, leading to jaundice.
- Infections: Infections like sepsis or TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes) can cause jaundice.
- Biliary Atresia: A condition in which there is obstruction of the bile ducts, causing conjugated hyperbilirubinemia and jaundice. 3. Breastfeeding Jaundice: - Caused by insufficient breastfeeding, leading to dehydration and a buildup of unconjugated bilirubin. Common in the first week of life.
Step 2: Presentation of Neonatal Jaundice:
1. Timing of Onset: - Physiological Jaundice: Typically appears after the first 24 hours and resolves within 1-2 weeks in full-term infants.
- Pathological Jaundice: Appears within the first 24 hours or persists for longer than usual. This requires further investigation. 2. Clinical Features: - Yellowing of the Skin and Sclera: The hallmark of jaundice. The severity is assessed by examining the extent of yellowing, starting from the face and progressing downward.
- Lethargy, Poor Feeding, and Vomiting: These can be signs of severe jaundice or an underlying illness.
- Dark Urine and Pale Stools: In cases of conjugated hyperbilirubinemia, such as biliary atresia, these symptoms can be present.
Step 3: Modalities for Treatment of Neonatal Jaundice:
1. Phototherapy: - The most common treatment for jaundice. Blue light helps convert unconjugated bilirubin into a more water-soluble form that can be excreted in the urine.
- The baby is placed under phototherapy lamps or a light-emitting pad, ensuring that the skin is exposed to light. 2. Exchange Transfusion: - Used in severe cases of jaundice, particularly when bilirubin levels are high enough to cause risk of kernicterus. It involves removing a portion of the infant's blood and replacing it with donor blood to quickly reduce bilirubin levels. 3. Intravenous Immunoglobulin (IVIG): - Used in cases of hemolytic jaundice caused by Rh or ABO incompatibility to reduce the level of hemolysis and the associated bilirubin production. 4. Treatment of Underlying Causes: - If jaundice is caused by an infection or metabolic disorder, specific treatment (e.g., antibiotics for infection or enzyme replacement for G6PD deficiency) will be necessary.
- In cases of biliary atresia, surgical interventions such as a Kasai procedure may be required to improve bile flow. 5. Improved Feeding: - Ensuring that the infant is well-fed can help prevent breastfeeding jaundice by improving hydration and increasing bowel movements to promote the elimination of bilirubin.