Hyperbilirubinemia in the term newborn (original) (raw)
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Clinical investigation of neonatal jaundice
Serum bilirubin levels of 93 neonates aged between 0 and 14 days were estimated. The bilirubin levels were determined spectrophotometrically at 570 nm (Direct) and 540 nm (Total) at the pediatric unit, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria using continuous sampling techniques. It was established that the number of neonates with hyperbilirubinemia decreased with age. The mean concentration of direct, indirect and total bilirubin of jaundiced neonates were significantly elevated (p<0.05) as compared to healthy neonates. There was, however, no significant different (p>0.05) in bilirubin levels between the age groups tested in this study. Neonatal Jaundice is a serious health problem concern with prolonged case that could be of grave or even fatal consequences. It is therefore pertinent from the result shown in this study that, close monitoring of bilirubin levels is essential during early infancy.
aundice is a common and mostly benign condition in neonates but because of the potential toxicity of bilirubin, neonates must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. Over 60 percent of term and 80 percent of preterm babies develop clinical jaundice during the first week of life. Clinical jaundice, in neonates appears first on the face at a serum bilirubin concentration of 5 mg per dl in contrast to adults who appear jaundiced when the serum bilirubin is greater than 2 mg per dl.
Perspective on Neonatal Hyperbilirubinemia
Internet Journal of Medical Update
Jaundice in newborns provides a different response from the parents when compared to jaundice in older children and adults. Physiologic hyperbilirubinemia occurs commonly in term newborn infants in the absence of any underlying pathologic cause. Yet, the jaundice itself is commonly regarded as a problem in the transition to extrauterine life. In Neonatal hyperbilirubinemia (NHB) the total bilirubin level is greater than 15mg/dL in 15 day or less old neonates and 2mg/dL in neonates above 15 days of age. Estimation of total bilirubin is preferred in the routine analyses for NHB compared to measurement of direct bilirubin. If certain conditions like sepsis, hepatic infections and other liver diseases are present it may be prudent to use direct bilirubin measurement. Yet contrary to the usual assumption of pathology, there are several lines of evidence supporting an adaptive role for neonatal hyperbilirubinemia. First, experimental and clinical evidence indicate that neonatal enzyme systems are not yet mature at birth; bilirubin has been demonstrated to scavenge potentially toxic oxygen free radicals that in later life are removed by the mature antioxidant enzyme system. Second, presence of bilirubin in mammals, similar patterns of expression of neonatal hyperbilirubinemia in nonhuman primates, and significant inter population variation in newborn serum bilirubin levels among humans all suggest that bilirubin production, metabolism, and excretion are under genetic control. Therefore bilirubin metabolism and its understanding may help improve its diagnosis and prognosis.
Understanding Neonatal Jaundice: A Perspective on Causation
Pediatrics & Neonatology, 2010
Neonatal jaundice can be best understood as a balance between the production and elimination of bilirubin, with a multitude of factors and conditions affecting each of these processes. When an imbalance results because of an increase in circulating bilirubin (or the bilirubin load) to significantly high levels (severe hyperbilirubinemia), it may cause permanent neurologic sequelae (kernicterus). In most infants, an increase in bilirubin production (e.g., due to hemolysis) is the primary cause of severe hyperbilirubinemia, and thus reducing bilirubin production is a rational approach for its management. The situation can become critical in infants with an associated impaired bilirubin elimination mechanism as a result of a genetic deficiency and/or polymorphism. Combining information about bilirubin production and genetic information about bilirubin elimination with the tracking of bilirubin levels means that a relative assessment of jaundice risk might be feasible. Information on the level of bilirubin production and its rate of elimination may help to guide the clinical management of neonatal jaundice. KEY WORDS : carbon monoxide; heme oxygenase; hyperbilirubinemia; jaundice; metalloporphyrin R. S. Cohen, MD
Neonatal Jaundice: Bilirubin Physiology and Clinical Chemistry
NeoReviews, 2007
Objectives After completing this article, readers should be able to: 1. Identify the sources and chemical forms of bilirubin in the body. 2. Delineate the normal metabolic pathways for bilirubin production. 3. Describe how bilirubin is transported in the body. 4. Delineate the normal metabolic pathway for bilirubin excretion. 5. Differentiate and appreciate the limitations of the various methods used to measure bilirubin.
The Indian Journal of Pediatrics, 2001
Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10% of all newborns require intervention for pathological jaundice. Neonates on exclusive breastfeeding have a different pattern of physiological jaundice as compared to artificially fed babies. Guidelines from American Academy of Pediatrics (AAP) for management of jaundice in a normal term newborn have been included in the protocol. Separate guidelines have been provided for the management of jaundice in sick term babies, preterm and low birth weight babies, for jaundice secondary to hemolysis and for prolonged hyperbilirubinemia. Although hour specific bilirubin charts are available, these have to be validated in Indian infants before they are accepted for widespread use.
Rebound hyperbilirubinemia in a sample of newborns with jaundice
Background and objectives: Neonatal jaundice represents a prevalent public health problem in Erbil city. Rebound jaundice after termination of phototherapy is common and related to many factors, so the aim of the study is to estimate the prevalence of rebound jaundice among neonates after termination of phototherapy and identifying any associated factors. Method: A cross sectional study was conducted in Neonatal Care Unit of Raparin Teaching Hospital in Erbil during the period from 1st of September, 2018 to 28th of February, 2019 on sample of 100 neonates with jaundice. The selected neonates were followed for up to 72 hours after discharge from hospital. Total serum bilirubin levels of neonates were measured at admission, on discharge and within 72 hours of phototherapy termination. Results: The rebound jaundice was present in 20% of neonates after stopping the phototherapy. Those were significantly related to certain socioeconomic and clinical data like (male gender, prematurity, low birth weight, Glucose-6-phosphate dehydrogenase deficiency, higher total serum bilirubin at admission, lower total serum bilirubin at discharge, low hemoglobin, high reticulocyte counts and shorter phototherapy duration). Conclusions: The prevalence of rebound jaundice after termination of phototherapy was high. So follow up is mandatory within 72 hours of phototherapy termination.
International Journal of Biomedical and Advance Research, 2011
Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this article is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. This article provides a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation.
Unconjugated pathological jaundice in newborns
Collegium antropologicum, 2014
Neonatal jaundice is the occurrence of elevated bilirubin levels in the blood. It may be physiological or pathological. If the concentration of non-conjugated bilirubin in the blood is too high, it breaches the blood brain barrier and bilirubin encephalopathy occurs with serious consequences for the child. The aim of the research was to examine the incidence frequency of unconjugated pathologic jaundice in newborns and connect it to some epidemiological variations (medical, social, demographic) as well as to prove the increased frequency of jaundice in children born by stimulation and labour induction. The study included 800 infants: 198 (24.8%) of them did, and 602 (75.2%) did not suffer from jaundice. Statistical analysis confirmed the association between the onset of jaundice in newborns and the following parameters: gestational age, birth weight, maternal infections and other illnesses during pregnancy and premature rupture of membranes as complications during labor and the mode...