विवरण
Hyperbilirubinemia is a common condition in newborn infants, and its management is crucial to prevent severe complications such as kernicterus. The American Academy of Pediatrics (AAP) has published guidelines for the management and prevention of hyperbilirubinemia in newborn infants ≥35 weeks’ gestation. Infants with risk factors for hyperbilirubinemia require closer monitoring than infants without risk factors. Determining the presence of these risk factors requires examining the infant, assessing laboratory data, and obtaining a family history of blood disorders or neonatal jaundice. Phototherapy is an effective treatment for hyperbilirubinemia, but the number needed to treat varies widely depending on sex, gestational age, and other factors.
सारांश
- Neonatal hyperbilirubinemia, defined as elevated bilirubin levels in newborns (birth to 28 days), requires careful assessment in daylight to differentiate from normal adult bilirubin values. Diagnosis involves clinical observation for jaundice starting from the head and progressing downwards, and confirmation with bilirubin level measurements. Particular attention should be given to yellowing of palms and soles, which indicates high bilirubin levels.
- Accurate diagnosis involves considering the baby's age in hours, bilirubin level (in mg/dL or mcg/dL), and gestational age. These factors, combined with risk factors like G6PD deficiency and ABO/Rh incompatibility, are plotted on a hyperbilirubinemia nomogram to determine the need for monitoring, phototherapy, or exchange transfusion. Early identification is crucial to prevent complications.
- Bilirubin metabolism in newborns differs from adults, with slower hepatic conjugation of unconjugated bilirubin and reduced enterohepatic circulation of urobilinogen. This leads to physiological jaundice, which is common in newborns. However, monitoring is essential to prevent unconjugated bilirubin from crossing the blood-brain barrier, potentially causing kernicterus and adverse neurodevelopmental outcomes.
- Various factors contribute to hyperbilirubinemia in newborns, including shorter red blood cell lifespan, lower albumin capacity, and decreased hepatic enzyme activity. Increased enterohepatic circulation due to slower gut motility further elevates bilirubin levels. Early-onset jaundice (within 24 hours) and rapid bilirubin increase warrant immediate investigation.
- Physiological jaundice typically appears after 24 hours and peaks between 4-5 days in term infants and 7 days in preterm infants. Breastfeeding jaundice (due to inadequate milk intake) and breast milk jaundice (due to breast milk factors) are common variants. Pathological jaundice, conversely, presents within 24 hours or demonstrates a rapid bilirubin increase.
- Hemolytic diseases like Rh and ABO incompatibility are significant causes of pathological jaundice. Infections (sepsis, malaria), G6PD deficiency, and polycythemia also increase bilirubin levels. Cephalohematoma and other hemorrhages can contribute as well. Differential diagnosis includes considering biliary atresia, metabolic disorders, and congenital hypothyroidism.
- A comprehensive workup includes detailed maternal history, perinatal history, physical examination, and laboratory investigations. Lab tests encompass blood grouping (mother and infant), hematocrit, reticulocyte count, liver function tests, sepsis screening, and G6PD deficiency testing. Transcutaneous bilirubinometry serves as a screening tool, requiring confirmation with blood tests for elevated readings.
- Phototherapy uses specific wavelengths of light to convert unconjugated bilirubin into water-soluble isomers for excretion. Effective phototherapy necessitates uncovered skin exposure (except for eyes and genitals), appropriate distance between the light source and infant, regular flux checks, and temperature monitoring. Increased fluid intake is often required to compensate for dehydration from phototherapy.
- Exchange transfusion is considered for severe hyperbilirubinemia to remove bilirubin and antibodies, and replace red blood cells. Blood selection varies based on the underlying cause (ABO incompatibility, Rh immunization). Phenobarbital and IVIG are adjunctive therapies used to reduce bilirubin levels and hemolysis, respectively. Albumin infusions can help prevent bilirubin-induced neurotoxicity.
- Conjugated hyperbilirubinemia (direct bilirubin >2 mg/dL) requires prompt investigation, particularly for biliary atresia. Distinguishing factors include dark urine and pale stools. A thorough evaluation for metabolic disorders, congenital infections, and other causes is crucial. Timely diagnosis and management are critical for optimal outcomes and to prevent long-term complications like cirrhosis.
नमूना प्रमाण पत्र
वक्ताओं के बारे में
डॉ. विशाल परमार
MBBS, DCH, MRCPCH Fellow in Neonatal Medicine PGPN Bostan Pediatrician Mumbai, India.
टिप्पणियाँ
टिप्पणियाँ
टिप्पणी करने के लिए आपको लॉगिन होना होगा।