ОМ 005-2
Examined by: Amantaeva M. E.
Almaty 2016
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Algoritm of differencial diagnosis of Neonatal Jaundice Done: Tolegenova
Содержание
- 1. Algoritm of differencial diagnosis of Neonatal Jaundice Done: Tolegenova
- 2. Слайд 2
- 3. NJ - Teaching Aids: NNFNeonatal JaundiceVisible form
- 4. NJ - Teaching Aids: NNFWhat is the
- 5. NJ - Teaching Aids: NNFSpecial characteristic in
- 6. NJ - Teaching Aids: NNFBilirubin metabolismHb →
- 7. NJ - Teaching Aids: NNFClinical assessment of
- 8. NJ - Teaching Aids: NNFPhysiological jaundice CharacteristicsAppears
- 9. NJ - Teaching Aids: NNFWhy does physiological
- 10. Course of physiological jaundice
- 11. NJ - Teaching Aids: NNFPathological jaundiceAppears within
- 12. NJ - Teaching Aids: NNFCauses of jaundiceAppearing
- 13. NJ - Teaching Aids: NNFCauses of jaundiceAfter
- 14. NJ - Teaching Aids: NNFThe general symptoms
- 15. NJ - Teaching Aids: NNFRisk factors for
- 16. NJ - Teaching Aids: NNFCommon causes
- 17. NJ - Teaching Aids: NNFApproach to jaundiced
- 18. NJ - Teaching Aids: NNFWorkup Maternal &
- 19. NJ - Teaching Aids: NNFManagementRationale: reduce level
- 20. NJ - Teaching Aids: NNFPrinciple of phototherapyNative
- 21. NJ - Teaching Aids: NNFPhototherapy equipmentWhite light
- 22. Babies under phototherapyBaby under conventional phototherapyBaby under triple unit intense phototherapy
- 23. NJ - Teaching Aids: NNFPhototherapyTechniquePerform hand washPlace
- 24. NJ - Teaching Aids: NNFPhototherapyFrequent extra breast
- 25. NJ - Teaching Aids: NNFSide effects of
- 26. NJ - Teaching Aids: NNFChoice of blood
- 27. Maisel’s chart
- 28. NJ - Teaching Aids: NNFProlonged indirect jaundiceCausesCrigler Najjar syndromeBreast milk jaundiceHypothyroidismPyloric stenosisOngoing hemolysis, malaria
- 29. NJ - Teaching Aids: NNFConjugated hyperbilirubinemia SuspectHigh
- 30. NJ - Teaching Aids: NNFConjugated hyperbilirubinemia Causes
- 31. Скачать презентанцию
NJ - Teaching Aids: NNFNeonatal JaundiceVisible form of bilirubinemia Adult sclera >2mg / dlNewborn skin >5 mg / dlOccurs in 60% of term and 80% of preterm neonatesHowever, significant jaundice occurs
Слайды и текст этой презентации
Слайд 1Algoritm of differencial diagnosis of Neonatal Jaundice
Done: Tolegenova G.O.
Examined by: Amantaeva M. E.
Almaty 2016
Слайд 3NJ -
Teaching Aids: NNF
Neonatal Jaundice
Visible form of bilirubinemia
Adult
sclera >2mg / dl
Newborn skin >5 mg / dl
Occurs in
60% of term and 80% of preterm neonatesHowever, significant jaundice occurs in 6 % of term babies
Слайд 4NJ -
Teaching Aids: NNF
What is the Neonatal Jaundice?
Neonatal Jaundice(also
called Newborn jaundice) is a condition marked by high levels
of bilirubin in the blood.The increased bilirubin cause the infant's skin and whites of the eyes(sclera) to look yellow.
Слайд 5NJ -
Teaching Aids: NNF
Special characteristic in neonates
1)More billirubin produced
Much more hemolysis
The life-length of hemolysis(70-80)
2)The low capability
of albumin on unconjugated billirubin transportation Acid intoxication
Less albumin in neonates
Слайд 6NJ -
Teaching Aids: NNF
Bilirubin metabolism
Hb → globin + haem
1g
Hb = 34mg bilirubin
Non – heme source
1 mg / kg
Bilirubin
glucuronidaseBilirubin
Bilirubin
Ligandin
(Y - acceptor)
Bil glucuronide
Intestine
Bil glucuronide
Stercobilin
bacteria
β glucuronidase
Слайд 7NJ -
Teaching Aids: NNF
Clinical assessment of jaundice
Area of body
Bilirubin levels mg/dl
Face 4-8
Upper trunk 5-12
Lower trunk & thighs 8-16
Arms and
lower legs 11-18Palms & soles > 15
Слайд 8NJ -
Teaching Aids: NNF
Physiological jaundice
Characteristics
Appears after 24 hours
Maximum intensity
by 4th-5th day in term & 7th day in preterm
Serum
level less than 15 mg / dlClinically not detectable after 14 days
Disappears without any treatment
Note: Baby should, however, be watched for worsening jaundice
Слайд 9NJ -
Teaching Aids: NNF
Why does physiological jaundice develop?
Increased
bilirubin load
Defective uptake from plasma
Defective conjugation
Decreased excretion
Increased entero-hepatic circulation
Слайд 11NJ -
Teaching Aids: NNF
Pathological jaundice
Appears within 24 hours of
age
Increase of bilirubin > 5 mg / dl / day
Serum
bilirubin > 15 mg / dlJaundice persisting after 14 days
Stool clay / white colored and urine staining clothes yellow
Direct bilirubin> 2 mg / dl
Слайд 12NJ -
Teaching Aids: NNF
Causes of jaundice
Appearing within 24 hours
of age
Hemolytic disease of NB : Rh, ABO
Infections: TORCH, malaria,
bacterialG6PD deficiency
Appearing between 24-72 hours of life
Physiological
Sepsis
Polycythemia
Concealed hemorrhage
Intraventricular hemorrhage
Increased entero-hepatic circulation
Слайд 13NJ -
Teaching Aids: NNF
Causes of jaundice
After 72 hours of
age
Sepsis
Cephalhaematoma
Neonatal hepatitis
Extra-hepatic biliary atresia
Breast milk jaundice
Metabolic disorders
Слайд 14NJ -
Teaching Aids: NNF
The general symptoms of Neonatal Jaundice
Yellow
skin
Yellow eyes(sclera)
Sleepiness
Poor feeding in infants
Brown urine
Fever
High-pitch
cryvomiting
Слайд 15NJ -
Teaching Aids: NNF
Risk factors for jaundice
JAUNDICE
J
- jaundice within first 24 hrs of life
A - a
sibling who was jaundiced as neonate U - unrecognized hemolysis
N – non-optimal sucking/nursing
D - deficiency of G6PD
I - infection
C – cephalhematoma /bruising
E - East Asian/North Indian
Слайд 16NJ -
Teaching Aids: NNF
Common causes
Physiological
Blood group incompatibility
G6PD deficiency
Bruising
and cephalhaematoma
Intrauterine and postnatal infections
Breast milk jaundice
Слайд 17NJ -
Teaching Aids: NNF
Approach to jaundiced baby
Ascertain birth weight,
gestation and postnatal age
Assess clinical condition (well or ill)
Decide whether
jaundice is physiological or pathologicalLook for evidence of kernicterus* in deeply jaundiced NB
*Lethargy and poor feeding, poor or absent Moro's, opisthotonus or convulsions
Слайд 18NJ -
Teaching Aids: NNF
Workup
Maternal & perinatal history
Physical examination
Laboratory tests
(must in all)*
Total & direct bilirubin*
Blood group and Rh for
mother and baby*Hematocrit, retic count and peripheral smear*
Sepsis screen
Liver and thyroid function
TORCH titers, liver scan when conjugated hyperbilirubinemia
Слайд 19NJ -
Teaching Aids: NNF
Management
Rationale: reduce level of serum bilirubin
and prevent bilirubin toxicity
Prevention of hyperbilirubinemia: early feeds, adequate hydration
Reduction
of bilirubin levels: phototherapy, exchange transfusion, drugs
Слайд 20NJ -
Teaching Aids: NNF
Principle of phototherapy
Native bilirubin Photo
isomers of bilirubin
Insoluble Soluble
450-460nm
of light
Слайд 21NJ -
Teaching Aids: NNF
Phototherapy equipment
White light tubes 6-8*/ 4
blue light tubes
Cradle or incubator
Eye shades
*May use 150 W halogen
bulb
Слайд 22Babies under phototherapy
Baby under conventional phototherapy
Baby under triple unit intense
phototherapy
Слайд 23NJ -
Teaching Aids: NNF
Phototherapy
Technique
Perform hand wash
Place baby naked in
cradle or incubator
Fix eye shades
Keep baby at least 45 cm
from lights, if using closer monitor temperature of babyStart phototherapy
Слайд 24NJ -
Teaching Aids: NNF
Phototherapy
Frequent extra breast feeding every 2
hourly
Turn baby after each feed
Temperature record 2 to 4 hourly
Weight
record- dailyMonitor urine frequency
Monitor bilirubin level
Слайд 25NJ -
Teaching Aids: NNF
Side effects of phototherapy
Increased insensible water
loss
Loose stools
Skin rash
Bronze baby syndrome
Hyperthermia
Upsets maternal baby interaction
May result
in hypocalcemia
Слайд 26NJ -
Teaching Aids: NNF
Choice of blood for exchange
blood transfusion
ABO
incompatibility
Use O blood of same Rh type, ideal O cells
suspended in AB plasmaRh isoimmunization
Emergency 0 -ve blood Ideal 0 -ve suspended in AB plasma or baby's blood group but Rh -ve
Other situations
Baby's blood group
Слайд 28NJ -
Teaching Aids: NNF
Prolonged indirect jaundice
Causes
Crigler Najjar syndrome
Breast milk
jaundice
Hypothyroidism
Pyloric stenosis
Ongoing hemolysis, malaria
Слайд 29NJ -
Teaching Aids: NNF
Conjugated hyperbilirubinemia
Suspect
High colored urine
White or
clay colored stool
Caution
Always refer to hospital for investigations so
that biliary atresia or metabolic disorders can be diagnosed and managed early
Слайд 30NJ -
Teaching Aids: NNF
Conjugated hyperbilirubinemia
Causes
Idiopathic neonatal hepatitis
Infections -Hepatitis
B, TORCH, sepsis
Biliary atresia, choledochal cyst
Metabolic -Galactosemia, tyrosinemia, hypothyroidism
Total parenteral
nutrition
