Wednesday, 19 December 2007

MRCOG Neonatal Jaundice

Why it is important to recognise and treat neonatal jaundice?

Bilirubin is toxic to the brain.
Uncojugated bilirubin is lipid soluble but conjugated bilirubin is water soluble.

Bilirubin is prevented from entering the brain by blood brain barrier under normal circumstances.However the blood brain barrier isn’t well developed in the newborn.Uncojugated bilirubin(lipid soluble) could cross to the newborn and would cause encephalopathy.(Kernicterus)

Fetal bilirubin is excreted via placenta and is cleared by maternal liver. Once delivered baby’s liver should take over.

Causes of neonatal jaundice could be broadly categorised as

(i)prehepatic(excessibiliruve bin production
(ii)intrahepatic(interference with conjugation)
(iii)posthepatic(excrreducted ion)

Examples :
(A) Prehepaticprehepatic:haemolytic anaemia-Rhesus incompatibility/ABO incompatibility
(B) Intrahepatic:prematurity-liver enzymes system is immature to handle the conjucation
(C) Post hepatic:Biliary atresia, Choledochal cyst

useful powerpoint presentations

1.Power point 1