NEONATAL JAUNDICE BY DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER...
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Transcript of NEONATAL JAUNDICE BY DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER...
NEONATAL JAUNDICE
BY
DR BLESSING OFEJIRO OKPERI B.Med.Sc.(Hons), MBBS, FWACP (Paed) SENIOR LECTURER / CONSULTANT PAEDIATRICIAN H.O.D, DEPT OF PAEDIATRICS,
DELSU & DELSUTH.
MEDICAL DIRECTOR RAPHA SPECIALIST CHILDREN & GENERAL CLINIC, 85
AIRPORT ROAD, EFFURUN.
PRE - TEST
• What the causes jaundice in neonates?
• How is jaundice diagnosed?
• What is physiologic jaundice?
• Which of the following is useful for Rx :
(a) Early morning sunlight
(b) Glucose + Ampiclox
(c ) Phenobarbitone
LEARNING OBJECTIVES
• DEFINE JAUNDICE
• PATHOPHYSIOLOGY OF JAUNDICE
• DANGER OF JAUNDICE
• DEBUNKING WRONG TREATMENTS
• EMPHASIZING PROMPT & EFFECTIVE
TREATMENT
INTRODUCTION
DEFINITION
PREVALENCE
BURDEN OF THE DISEASE
BILIRUBIN METABOLISM
• SOURCES OF BILIRUBIN• HEMOLYSIS• BILIRUBIN BINDING TO ALBUMIN• LIVER UPTAKE• BINDING TO LIGADIN Y & Z• CONJUGATION WITH UDPGT• EXCRETION INTO BILE• ENTEROHEPATIC CIRCULATION
PHYSIOLOGIC JAUNDICE
• DEFINITION
• CAUSES
• - RBC VOL ,RBC SURVIVAL,ELB,EHC
• -DEFECTIVE UPTAKE
• -DEFECTIVE CONJUGATION
• -REDUCED EXCRETION
• RATE OF RISE AND PEAK
PATHOLOGIC JAUNDICE
• DEFINITION
• CAUSES
• -POLYCYTHAEMIA
• -HEMOLYSIS
• -BILIRUBIN DISPLACEMENT
• -HEPATOBILIARY DISEASES
• RATE OF RISE AND PEAK
BILIRUBIN TOXICITY
• PATHOLOGY: UNCOUPLING OF OXIDATIVE PHOSPHORILATION, NEURONAL CELL DEATH
• WORSE HIT:BASALGANGLIA,GLOBUS PALLIDUS,PUTAMEN,CAUDATE
NUCLEI• + CH, BULBAR & CEREBELLAR
NUCLEI
CLINICAL STAGING
1.POOR MORO,HYPOTONIA,LETHARGY POOR FEEDING, HIGH PITCH CRY2.OPISTHOTONUS,HYPERTONIA,FEVER SEIZURES,ROWING “BICYCLING” PARALYSIS OF UPWARD GAZE3.APPARENT RECOVERY4.LATE SEQUELAE: SPASTICITY,ATHETOSIS COMPLETE OR PARTIAL DEAFNESS, CP, MR
CLINICAL EVALUATION
• VISUAL ESTIMATION(ROUGH GUIDE)
• SB (TOTAL & CONJUGATED)
• PCV & COOMBS
• CONJ BIL < 2mg% VERSUS > 2mg %
• PCV HIGH VS NORMAL OR LOW
• RETIC NORMAL VS ABNORMAL
TREATMENT
• PHOTOTHERAPY:INDICATIONS,MOA
LIGHT SOURCE, TECHNIQUE, PHOTO
BLANKET• EBT; INDICATIONS,MOA, TECHNIQUE• PHENOBARBITONE: MOA, DEMERITS
CONTEMPORARY INDICATIONS• ACTIVATED CHARCOL• TIN PROTOPORPHYRIN
CONCLUSION
• NO ROASTING OF BABY IN THE SUN
• NO AMPICLOX AND GLUCOSE
• NO DELAY TO REFER BABY
• STOP CEREBRAL PALSY PLEASE!!!!!