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This document summarizes key information about bilirubin levels and jaundice in neonates. It discusses normal and abnormal bilirubin levels that can cause jaundice, the mechanisms behind different types of hyperbilirubinemia, methods for assessing jaundice severity, and potential neurological effects of severe hyperbilirubinemia like kernicterus. Common syndromes involving impaired bilirubin conjugation or transport are also outlined.
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Level of bilirubin to cause jaundice in older children and adults
This document summarizes key information about bilirubin levels and jaundice in neonates. It discusses normal and abnormal bilirubin levels that can cause jaundice, the mechanisms behind different types of hyperbilirubinemia, methods for assessing jaundice severity, and potential neurological effects of severe hyperbilirubinemia like kernicterus. Common syndromes involving impaired bilirubin conjugation or transport are also outlined.
This document summarizes key information about bilirubin levels and jaundice in neonates. It discusses normal and abnormal bilirubin levels that can cause jaundice, the mechanisms behind different types of hyperbilirubinemia, methods for assessing jaundice severity, and potential neurological effects of severe hyperbilirubinemia like kernicterus. Common syndromes involving impaired bilirubin conjugation or transport are also outlined.
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