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Professor
Mohamed Khashaba
Professor of Pediatrics
Unconjugated bilirubin
Enterohepatic
Gut circulation
Excretion as Deconjugation
urobilinogen & (glucuronidase)
stercobilinogen
• What’s the commonest cause of neonatal jaundice?
jaundice?
Physiologic jaundice
beneficial).
∀ ↑ ed hemolysis
• Deficient conjugution (unconjugated hyperbili-
rubinemia).
∀ ↓excretion (conjugated hyperbilirubinemia).
Unconjugated Conjugated
↑ Hemolysis: ↓ conjugation:
* Rh. incompatibility
* Criggler Najjar syndrome
* ABO incompatibility
* Inhibited enzyme:
* Heriditary hemolytic anemia -Hypoxia
* Infections -Acidosis
* Extravasated blood -Hypothyroidism
* Polycythemia -Breast milk jaundice
Mg/dl Hemolysis
Serum bilirubin
Physiological jaundice
2 4 6 8 10 12 14
Day of life
M.Khashaba,MD professor of Pediatrics,Mansoura
Persisting Prolonged Jaundice
• Unconjugated:
– Hypothyroidism.
– Pyloric stenosis.
– Breast milk jaundice.
– Griggler-Najjar syndrome.
• Conjugated
• Pathological.
• Prompt diagnosis and referral to a specialized
center is needed.
1. Biliary atresia.
2. Neonatal hepatitis.
3. α1 Antitrypsin deficiency.
4. Inspissated bile syndrome
Theory:
• Breast milk contains substances which interfere with
conjugation (Non esterified LCFA).
Value:
• D.D of prolonged jaundice.
• Non harmful to the baby.
Stoppage of breast feeding is not recommended.
• Diagnosis is by exclusion.
1. Serum bilirubin.
2. Blood group.
3. Coomb’s test.
4. Blood picture , including Retic. count.
• Intrauterine infection.
fe tus (A or B)
First baby usually not affe cte d First baby may be affe cte d
Incre ase severity of dise ase with successive No re lation be twee n seve rity & birth orde r
pre gnancy
Live r & spleen usually palpable Live r & spleen not us ually palpable
Diagnosis:
Continue
Pathophysiology:
• Serum unconjugated bili. Exceeds carrying
capacity of serum albumin.
• A level of >25 mg/dl of bili. Is critical.
• Factors disturbing BBB increase vulnerability
of brain cells.
3. Oxidative phosphorylation .
4. DNA synthesis.
5.Protein Phosphorylation.
6.Neurotransmittor synthesis.
7. Ion transport.
8.Synaptic transmission.
Early signs:
• Poor feeding.
• Impaired reflexes.
• Altered consciousness.
• Convulsions & opisthotonus.
• Mental retardation.
• C.P.
• Deafness.
• Phototherapy.
• Indications of phototherapy:
– Serum unconjugated bili. 12-25 mg/dl in
healthy full terms.
– Lower levels in:
• Preterm & sick baby.
• Hemolytic jaundice.