1.

Level of bilirubin 2-3 mg/dL (34-51 μmol/L)

to cause jaundice
in older children
and adults.
2. In neonates >5 mg/dL (>85 μmol/L)
3. Neurotoxic Unconjugated/Indirect
4. Enzyme Uridine glucoronyl transferase
responsible for
conjugation of
indirect bilirubin.
5. Major conjugated stercobilin
bilirubin is
excreted as?
6. RBC lifespan in 70-90 days
newborn
7. Unconjugated  Increases the load of bilirubin to be metabolized by the liver
hyperbilirubinemi  Damages or reduces the activity of the transferase enzyme or other
a related enzymes
 Competes for or blocks the transferase enzyme
 Leads to an absence or decreased amounts of the enzyme or to
reduction of bilirubin uptake by liver cells
8. Bilirubin level in 1 mg/dl
meconium
9. Conjugated Decrease excretion of conjugated bilirubin
hyperbilirubinemi Deficiency in canalicular membrane transport
a Drug induced canalicular membrane dysfunction
Hepatocellular damage or toxicity
EXTRA HEPATIC BILIARY OBSTRUCTION
DECREASED INTRAHEPATIC BILE FLOW

10. Modified Kramer’s Face – 4-6

Chest, upper abdomen – 8-10
Lower abdomen, thighs – 12-14
Arms, Lower legs – 15-18
Palms, soles – 15-20
11. Physiologic Icterus neonatorum
jaundice Breakdown of fetal RBCs
Transient limitation in the conjugation of bilirubin by the immature neonatal
liver
12. Pathologic Within first 24 hours of life
jaundice Beyond 2 weeks of life
13. <24 hour jaundice ABO incompatibility
Rh incompatibility
TORCH infection
14. Gilbert syndrome Decreased production of glucuronyl transferase causing exaggerated
physiologic jaundice
30% UGT1A1 activity
15. >14 days G6PD, post-hepatic hyperbilirubinemia, inborn errors of metabolism
16. Criggler-Najar Type I – no UGT1A1 activity
syndrome Type II - <10% UGT1A1 activity; responds to phenobarbital
17. Dubin-Johnson Problem with excretion of conjugated bilirubin
syndrome
18. Rotor syndrome Mild conjugated hyperbilirubinemia
19. Common initial Lethargy
signs of Poor feeding
kernicterus Loss of the Moro reflex
20. Direct ≥ 20% of total bilirubin
hyperbilirubinemi >2 mg/dl
a >7 days
Associated hepatobiliary pathology
21. Phototherapy Isomerization
22. Bilirubin Chronic bilirubin encephalopathy
encephalopathy Athetoid cerebral palsy
Gaze paralysis
Hearing loss
23. BILIRUBIN Muscle tone abnormalities
INDUCED Hyperexcitable neonatal reflexes
NEUROLOGIC Speech and language difficulties
DYSFUNCTION Sensorineural hearing loss
Visuomotor dysfunction
24. BILIRUBIN- Evaluate auditory brainstem-evoked response (ABR) to identify bilirubin
INDUCED toxicity in babies who have had significant hyperbilirubinaemia
AUDITORY
TOXICITY