neonatal jaundice

INTRODUCTION

Neonatal 
jaundice  is  a 
term  for  elevated 
total  serum bilirubin in  newborns and 
infants less than one month of age. In other
words neonatal Jaundice is the yellowish coloration of the skin and the white
part of the eye (the sclera). 1 Neonatal  jaundice  
occurs  in  60 % 
of  term  healthy 
neonates  and  80 % 
of  preterm  neonates.2
It results from having too much of substance called bilirubin in the blood.
Bilirubin is formed when the body breaks down old red blood cells. The liver
usually processes and removes the bilirubin from the blood.  Neonatal 
jaundice  in  babies 
usually  occurs  because 
of  a   normal increase  in 
the  red  blood 
cell  break  down 
and  the  fact 
that  their  immature livers are  not 
efficient  at  removing 
bilirubin  from  the 
bloodstream.

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There are mainly two types of neonatal jaundice.

·        
Physiological  jaundice

·        
Pathological  jaundice           

 

PHYSIOLOGICAL
JAUNDICE is due to the physiologic immaturity,
immaturity in bilirubin  metabolism 
at  multiple  steps 
results  in  the 
occurrence  of  neonatal 
jaundice  in  the 
first  few  days 
of  life .

CHARACTERS OF PHYSIOLOGIC JAUNDICE   :

First appears between 24-72 hours
of age, Maximum intensity seen on 4-5th day in term neonates, Does
not exceed 15 mg/dl and clinically undetected after 14 days.

 

 

 

 

PATHOLOGICAL JAUNDICE:  

Bilirubin
levels that deviate from Normal   range
and   require intervention i.e.   presence 
of  any  of 
the  following   signs 
denotes  that   jaundice 
is  pathological. Treatment   is  
required   in the form of
phototherapy.

 Clinical jaundice detected before 24 hours of
age,   Rise in serum  bilirubin 
by more  than  5 mg/ dl/ day,  Serum 
bilirubin  more  than 
15 mg / dl,  Jaundice  persisting 
beyond  14  days 
of  life and  direct 
bilirubin  >2 mg / dl  at  any
time.

 

Jaundice comes
from the French word “jaune”, which means yellow. When it is said that a baby
is jaundiced, it simply means that the color of his skin appears yellow.
Jaundice in the infant appears first in the face and upper body and progresses
downward toward the toes. Premature infants are more likely to develop jaundice
than full-term babies. 3

 

In neonates, jaundice tends to develop
because of two factors – the breakdown of fetal hemoglobin as it is replaced
with adult hemoglobin and the relatively immature hepatic metabolic pathways
which are unable to conjugate and so excrete bilirubin as quickly as an adult.
This causes an accumulation of bilirubin in the blood , leading to the symptoms
of jaundice.4

 

Each year in India over one million newborns die before they complete
their first month of life, accounting for 30% of the world’s neonatal deaths.
India’s current neonatal mortality rate of 20 per 1000 live births .Asian
male babies and Native American ones are reported to be most affected by
Neonatal Jaundice13.4 million
babies need treatment for jaundice every year.5Nat

 

Amongst all age group neonates are most susceptible
to mortality and morbidity. According to UNICEF news letter on April 24, 2008
out of every four, a child dies under the age of one in the world, one is an
Indian child. The infant mortality rate in the country is 67% per thousand live
births, in which neonatal mortality contributes 43.4 /1000 against the annual
death of 9 /1000 (2008). In India neonatal jaundice, contributes 4.55% death in
neonatal period. 6

 

According to the All India institute of
Medical Sciences protocol in neonatology, neonatal jaundice is the commonest
morbidity in neonatal period and 5-10% of all the newborns require
interventions for pathological jaundice. Neonates on exclusive breastfeeding
have different pattern of physiological jaundice as compared to artificially
fed babies. Separate guidelines have been provided for the management of
jaundice in sick term babies, preterm and low birth weight babies for jaundice
secondary to haemolysis and for prolonged neonatal jaundice. 7

 

Delayed initiation of breastfeeding or
insufficient feeding result in poor mobility of the gut,  that leads to poor excretion of bilirubin,
resulting in accumulation of bilirubin leading to hyperbilirubinemia.
Inadequate milk leads to delay the passage of meconium .Passage of baby through
the vagina during birth helps stimulate milk production in the mother. When the
baby is born by caesarian section the milk secretion is slightly delayed and
the mothers will also be in pain and in sedation, so the feeding is delayed,
these babies are at higher risk for this condition. Mothers should be aware of
initiating breastfeeding as early as possible, either she had caesarian section
or had a normal delivery. 8

 

The complication of hyperbilirubinemia
is kernicterus. It is due to the severe accumulation of unconjugated bilirubin.
According to a study by Nasrin Khalesi, kernicterus causes 10% of mortality and
70% of morbidity among neonates. However, the correct use of phototherapy and
timely blood exchange will control serum bilirubin level which can prevent
complications. 9

 

Many
cases of neonatal jaundice pass unnoticed or are identified late by mothers
making them present to hospitals late. 10 This can lead to complications such as bilirubin
encephalopathy and even death. Interventions to stop progression of neonatal
jaundice will reduce the morbidity and mortality associated with this
condition.11   It is therefore
important for mothers to recognize neonatal jaundice so as to seek for therapy
early and prevent complications that arise due to neonatal jaundice. 10 This
study is therefore designed to assess the knowledge, attitude and practice of
expectant mothers on NNJ with respect to their awareness, recognition,
knowledge of risk factors/ causes, complications, treatment modalities, and
initial step to take when it is noticed.

 

 

 

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