Physiological Jaundice

Jaundice is yellowish discoloration of the skin

and mucous membrane appears at two or three days old infant and begins to disappear towards the end of the first week. Physiological jaundice is common and

harmless About six out of

ten newborns have jaundice

to varying degrees, while the condition is more common among premature babies.

During life in the uterus, the RBCs of the fetus

contain fetal hemoglobin that is different than the adult hemoglobin. When an infant is born, the infant’s body begins to rapidly destroy the red blood cells containing the fetal-type hemoglobin and replaces them with red blood cells containing the adult-type hemoglobin. this leads to increase the production of bilirubin

The liver in a newborn infant is not mature,

and its ability to process and eliminate bilirubin is limited. As a result of both the influx of large amounts of bilirubin and the immaturity of the liver, bilirubin accumulates in the blood. Within two or three weeks, the destruction of

red blood cells ends, the liver matures, and the bilirubin levels return to normal

Breast feeding jaundice :

the mother's breasts produce small amounts of colostrum in the first few days after childbirth resulting in dehydration which may affect the function of the baby's liver. Breast milk jaundice: occurs during the second or third week of life, and may be caused by high levels of beta glucuronidase which inhibit beta glucuronyl transferase

The symptoms of jaundice depend on the cause and severity, but may include:  Yellowish tinge of the skin, appearing first on the skin of the face and scalp.  Yellowish tinge of the sclera.  In moderate jaundice, the yellowish tinge will spread to the skin of the body.  In severe jaundice, the palms of the hands and soles of the feet will turn yellow.  Unusual drowsiness.  Feeding difficulties.  In some cases, light-colored faeces and dark urine.

HISTORY:

Onset 2 to 3 days of age Peaks day 4 to 5, then improves LABORATORY

Total serum bilirubin concentration usually 5 to 12 mg/dL

Jaundice in the first day of life Unconjugated bilirubin level exceeds 12.9

mg/dl in full term infant Unconjugated bilirubin level exceeds 15 mg/dl in preterm infant Bilirubin level increasing at a rate of greater than 5 mg/ dl Conjugated bilirubin more than 2 mg/dl Clinical jaundice persisting more than 1week in full term or more than 2 weeks in preterm infants

Mild physiological jaundice if the baby is healthy and well, no treatment is necessary. The baby's liver will take only a few days to process bilirubin properly. Moderate to severe physiological

jaundice

Phototherapy to transform the bilirubin in skin into a less harmful chemical. Breast milk jaundice breastfeeding is almost always continued. Phototherapy is usually the primary treatment.

Presented by : Sarah Assem Round 3 – Group 1

References : http://www.thechildrenshospital.org/ http://www.kidshealth.org/ http://www.pediatriconcall.com/