Jaundice in the Newborn - New Born Baby

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Jaundice in the Newborn - New Born Baby

AIIMS- NICU protocols 20077.3. Transcutaneous bilirubinometer: This method is non invasive and based based onreflectance data of multiple wavelengths from the bilirubin stained skin. It averages thespectra of five replicate measurements at one site to give bilirubin estimation in mmol/l (ormg/dl). Transcutaneous bilimeter (TcB) has a linear correlation to TSB and may be usefulas a screening device to detect clinically significant jaundice and decrease the need forfrequent TSB determinations. 16 .8. Clinical approach to jaundice8.1 Is the newborn term or preterm?Basic pathophysiology of jaundice is same in term and preterm neonates but at lowergestation babies are at higher risk of developing hyperbilirubinemia and require closersurveillance and monitoring. TSB values for intervention also vary in term, near-term, andpreterm neonates less than 35 weeks period of gestation.Management of hyperbilirubinemia in preterm infants is still in grey zone for lack ofenough objective evidences. Clinical practice guidelines from American Academy ofPediatrics (AAP) applies to the newborn infants of 35 or more weeks of gestation. 178.2 Is there evidence of hemolysis?Setting of Rh or less frequently ABO incompatibility, onset of jaundice within 24 hours,presence of pallor and hydrops, presence of hepato-splenomegaly, presence of hemolysison the peripheral blood smear, raised reticulocyte count (>8%), rapid rise of bilirubin (>5mg/dl in 24 hours or >0.5 mg/dl/hr) or a suggestive family history of significant jaundiceshould raise a suspicion of hemolytic jaundice. However, end-tidal carbon monoxidecorrected for ambient carbon monoxide (ETCO c ) levels can confirm the presence orDownloaded from www.newbornwhocc.org 6

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