Thursday, 10 January 2008

MRCOG -Neontal Jaundice part 2

Neonatal jaundice can be broadly categorised into pyhsilogical or pathological jaundice.

Physiological jaundicepathological jaundice
Jaundice begins 24 hours after birth Jaundice may start before 24 hours
Jaundice would clear in a weekJaundice may last even 10 days after birth
Jaundice peaks 48-72 hoursrise rate greater than 5 mg/dL/24 hours
bilirubin levels greater than 12 mg/dL in full-term infants and 10-14 mg/dL/24 hours in preterm infants

Reason for physiological jaundice
(i)excessive haemoloysis-average fetal haemoglobin is higher than neonatal haemoglobin.
(ii)Hepatic immaturity(In intrauterine life placenta and maternal liver excretes bilirubin)

check this powerpoint presentation:Physiological Jaundice

Classification according to the time of onset

Time of onsetcauses
less than 24 hours haemolysis,sepsis(septicaemia),TORCH
24 hours to 10 daysphysiological jaundice, Crigler Najjar syndrome
Onset after 10 daysbiliary atresia,breast milk,galactosaemia,hypothyroidism,sepsis(urinary tract infection)

How does hypothyrodism causes neonatal jaundice?

Hypothyroidism slows down the metaboloism, so it would slow down the conjugation of bilirubin.It would cause unconjugated hyperbilirubinaemia.

How does galactosemia causes neonatl jaundice?

Galactosemia is metaboloic disorder caused by absence of enzyme metabolising Galactose.This leads to toxic levels of galactose causing hepatitis,cataract,renal failure and cataracts.One important long term complication is premature ovarian failure.

useful resources:(I)E medicine

useful powerpoint presentation:Neonatal Jaundice

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