Jaundice in the Newborn - New Born Baby

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AIIMS- NICU protocols 2007jaundice beyond 3 weeks and conjugated bilirubin (dark urine staining the clothes and lightcolored stool) would be categorized under pathological jaundice.4. Breast-feeding and jaundiceExclusively breast-fed infants have a different pattern of physiological jaundice ascompared to artificially fed babies. 7,9,10 Jaundice in breast-fed babies usually appearsbetween 24-72 hours of age, peaks by 5-15 days of life and disappears by the third week oflife. They have also been reported to have higher bilirubin levels. Schneider’s metaanalysisof 25 studies has shown that 13% of breast-fed babies had peak TSB levels of 12mg/dL or higher as compared to 4% of artificially fed babies. 11 One third of all breast-fedbabies are detected to have mild clinical jaundice in the third week of life, which maypersist into the 2 nd to 3 rd month of life in a few babies.Authors have stated that this increased frequency is not related to characteristics of breastmilk but rather to the pattern of breast-feeding. Decreased frequency of breast-feeding isassociated with exaggeration of physiological jaundice. Encouraging a mother to breastfeedher baby at least 10-12 times per day would be helpful in the management of jaundicein a term healthy baby.5. Breast milk jaundiceApproximately 2-4% of exclusively breast-fed term babies have jaundice in excess of 10mg/dL in the third week of life. 12,13 These babies with TSB beyond 10 mg/dL after the thirdweek of life should be investigated for prolonged jaundice. A diagnosis of breast milkjaundice should be considered if the TSB is predominantly unconjugated, other causes ofprolonged jaundice have been excluded and the infant is in good health. Mothers should beadvised to continue breast-feeding frequently intervals and TSB levels usually decline overDownloaded from www.newbornwhocc.org 4
AIIMS- NICU protocols 2007a period of time. Interruption of breast-feeding is not recommended unless TSB levelexceeds 20 mg/dl.6. Clinical examination of jaundiceOriginally described by Kramer 14 , dermal staining of bilirubin may be used as a clinicalguide to the level of jaundice. Dermal staining in newborn progresses in a cephalo-caudaldirection. The newborn should be examined in good daylight. The skin should be blanchedwith digital pressure and the underlying color of skin and subcutaneous tissue should benoted. A rough guide for level of dermal staining with level of bilirubin is included in Table1.Newborns detected to have yellow discoloration of the skin beyond the legs should have anurgent laboratory confirmation for levels of TSB. Clinical assessment is not very reliableif a newborn has been receiving phototherapy and if the baby has dark skin.7. Measurement of TSB levels7.1. Biochemical: Laboratory estimation of TSB based on High Performance LiquidChromatography (HPLC) remains the gold standard for TSB estimation. However this testis not universally available and laboratory estimation of TSB usually done in labs is basedon Vanden Bergh reaction. It usually have marked interlaboratory variability withcoefficient of variation up to 10 to 12 percent for TSB and over 20 percent for conjugatedfraction. 157.2 Micro method for bilirubin estimation: It is based on spectro-photometry andestimates TSB on a micro blood sample. It is useful in neonates, as bilirubin ispredominantly unconjugated.Downloaded from www.newbornwhocc.org 5
Page 1 and 2: AIIMS- NICU protocols 2007Jaundice
Page 3: AIIMS- NICU protocols 20071. Introd
Page 7 and 8: AIIMS- NICU protocols 2007absence o
Page 9 and 10: AIIMS- NICU protocols 200710. Hemol
Page 11 and 12: AIIMS- NICU protocols 2007be repeat
Page 13 and 14: AIIMS- NICU protocols 2007(e) TSB l
Page 15 and 16: AIIMS- NICU protocols 2007ABO incom
Page 17 and 18: AIIMS- NICU protocols 20078. Bhutan
Page 19 and 20: AIIMS- NICU protocols 2007Annexure:
Page 21 and 22: AIIMS- NICU protocols 2007Figure 2.
Page 23: AIIMS- NICU protocols 2007TABLE 4.

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