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mPHASE 1

Rapid rise in serum bilirubin levels to 12 to 15 mg /


dl

Lasts for 5 days in term infants,7 days in pre term


m PHASE 2
serum bilirubin level ~ 2 mg/ dl
lasts for 2 weeks in term infants,more than a
month in pre term & exclusively breast fed.
m rncreased bilirubin load on liver cells
m Defective hepatic uptake of bilirubin from plasma
m Defective bilirubin conjugation
m Defective bilirubin excretion
m °linical jaundice appearing in first 24 hours
m rncrease in total bilirubin by >0.5 mg/dl/hour or 5
mg/dl/24 hours
m Total bilirubin >15 mg/dl
m Direct bilirubin > 2 mg/dl
m r °REASED PRODU°TrO
1) Fetomaternal blood group incompatibility :
Rh,ABO
2) Hereditary spherocytosis
3) on spherocytic hemolytic anemia:G6PD
deficiency,PK deficiency,Vit.k induced hemolysis
4) Sepsis
5) rncreased enterohepatic circulation ,eg large
bowel obstruction
     
) rr rrr f t li : ri l r jjr
r t  

) r r : t rii,rtil
j i 
 Prematurity
 Small for gestational age
 Bruising,cephalhematoma
 Pallor
 Petechiae
 Hepatosplenomegaly
 Omphalitis
 Hypothyroidism
Dermal zone Body part involved Bilirubin(mg/dl)
1 Face,neck 5
2 °hest,Upper limbs 10
3 Abdomen,thighs 12
4 Legs 15
5 Palms & soles >15
ß TRA SrE T E °EPHALOPATHY

ß KER r°TERUS
m Yellowish staining & necrosis of neurons in basal
ganglia,hippocampus,subthalamic nuclei &
cerebellum

m °Lr r°ALLY :
r. Phase 1:poor suck,lethargy,hypotonia,depressed
sensorium
rr. Phase 2:fever,hypertonia,opisthotonus
rrr. Phase 3:high pitched cry,convulsions,death
2.)EX°HA GE
1.)PHOTOTHERAPY TRA SFUSrO
m rndications
‰  hen bilirubin levels may be hazardous to
infant,but not yet reached exchange transfusin
levels.
‰ Prophylactically in extremely low birth weight or
severely bruised infants.
m °omplications
1. rncreased insensible water loss

2. Diarrhoea
3. Retinal damage
4. Bronze baby syndrome
5. Hypocalcemia
m rndications
1. o response to phototherapy
2. To correct anemia & improve °°F in hydropic
infants
3. To stop hemolysis & production by removing
antibodies & sensitised rbc s
4. Septicemia
m °omplications
Ô Bacterial sepsis
Ô Thrombocytopenia
Ô Portal vein thrombosis
Ô Umblical or portal vein perforation
Ô Arrythmia,cardiac arrest
Ô Hypocalcemia,hypoglycemia,hypomagnesemia
Ô Metabolic acidosis,alkalosis
Ô HrV,HBV,H°V,GVHD
s Direct bilirubin > 2mg/dl or >15% of total bilirubin

s °auses ±
m Biliary atresia
m eonatal hepatitis
m Sepsis
m °lay coloured stools from day 4-5 of life
m Gradual decline in liver function
m Anemia & fat soluble vitamin deficiencies set in

m Types
1) Extra hepatic ± good prognosis,°BD or °HD
involved,surgery successful within 60 days
2) rntra hepatic ± poor prognosis,orthotopic liver
transplant needed
m Presents at 4-6 weeks of age
m Symptoms are usually intermittent,unlike biliary
atresia
m Presence of cholestatic inflammatory process with
giant cell transformation
m Addition of medium chain TG¶s,fat soluble vitamins
& repeated doses of vitamin K are useful.