Written by : Yunita Wulandari 030.08.

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Neonatal hyperbilirubinemia elevation of the bilirubin level in the blood yellowish staining of the skin and whites of the newborn's eyes (sclerae). In most infants normal phenomenon.

Healthy infants

up to 12mg% in 3rd day; in premature, 5th day.

No hemolysis or bleedings No underlying metabolic disease

Type of bilirubin : 1. Unconjugated bilirubin 2. Conjugated bilirubin Serum unconjugated bilirubin levels may excessively rise PROBLEM

 Gestational Age

Race
Family

history of jaundice requiring phototherapy Hemolysis (ABO or other) Severe bruising Breastfeeding

1.

2.

Infants have too many red blood cells and it is a natural process for the body to break down these excess red blood cells to form a large amount of bilirubin. The newborn's liver is immature and cannot process bilirubin as quickly as the infant will be able to when older.

Metabolism of heme. 6-10 mg/kg/day. (adults 34mg/kg/day) 1gr Hemoglobine produces 34mg of bilirubin 75%: from old RBCs released from RES 25%: from ineffective erythropoyesis, myoglobine, cytochromes, catalase, peroxidase.

Heme Oxygenase + O2

Heme Fe

Biliverdin + CO +

Biliverdin reductase

Indirect (unconjugated) bilirubin

Binds to albumin in plasma

Indirect bilirubin
Liver Uptake (binds to ligandin) Endoplasmic reticullum

Bilirubin

UDPG-T

Mono and diconjugated bilirubin

Liver
Elimination Enterohepatic recirculation Urobilinoids Stool Beta glucuronidase Bacteria

Gut

Yellow color of the skin. Sometimes, infants with significant jaundice have extreme tiredness and poor feeding.

Blanch skin with a finger Jaundice

Significant when appears at palms or below knees.

Transcutaneous bilirubinometer

Bruising, cephalohematoma, others.

Organomegaly

Phototherapy Exchange transfusion

Prolonged hyperbilirubinemia chronic bilirubin encephalopathy (kernicterus). Kernicterus fever, increased lethargy, and refusal to eat. High pitched crying.

Jaundice is a normal phenomenon, but can be a pathological case if bilirubin levels increase with extreme. Good management can have an impact both on the baby.

. Neonatal Hyperbilirubinemia. Available at : http://www.medterms.com/ script/main/art .asp?articlekey=16385. Accesed June 13, 2010. 2. Neonatal Jaundice. Encyclopedia of Childrens Health. Available at : http://www.healthofchildren.com/N-O/Neonatal-Jaundice.html. Accesed June13, 2010. 3. Neonatal Jaundice. Available at : http://emedicine.medscape.com/article/974786overview. Accesed June13, 2010. 4. Dennery P A, Seidman D S, Stevenson D K. Neonatal Hyperbilirubinemia. The New England Journal of Medicine 2001:344:581-90. Available at : http://content.nejm.org/cgi/content/full/344/8/581. Accesed June 13, 2010. 5. Juetschke, L.J. (2005, Mar/Apr). Kernicterus: still a concern. Neonatal Network, 24(2), 719, 59-62 6. Colletti JE, Kothari S, Kothori S, Jackson DM, Kilgore KP, Barringer K (November 2007)."An emergency medicine approach to neonatal hyperbilirubinemia". Emerg. Med. Clin. North Am. 25 (4): 111735, vii. 7. Watchko JF (December 2006). "Hyperbilirubinemia and bilirubin toxicity in the late preterm infant". Clin Perinatol 33 (4): 83952; abstract ix. 8. Shah Z, Chawla A, Patkar D, Pungaonkar S (March 2003). "MRI in kernicterus". Australas Radiol 47 (1): 557. 9. Malik BA, Butt MA, Shamoon M, Tehseen Z, Fatima A, Hashmat N (December 2005). "Seizures etiology in the newborn period". J Coll Physicians Surg Pak 15 (12): 78690. 10. Vohr BR, Lester B, Rapisardi G, et al. (August 1989). "Abnormal brain-stem function (brain-stem auditory evoked response) correlates with acoustic cry features in term infants with hyperbilirubinemia". J. Pediatr. 115 (2): 3038.
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