Neonatal

jaundice (NNJ)
and its
management
By: Latifah Alsahaley, Israa
Alagnam
Outlin
e
01 03
Definition of Causes of Neonatal
NNJ jaundice
02 04
Types of NNJ management of
Neonatal jaundice
Definition of
Neonatal jaundice
(NNJ) is theNNJ
yellowish
discoloration of the
skin and sclerae
seen in primary
care(newborns). It is
caused by high
levels of bilirubin in
the blood.
Definition of NNJ
High levels of bilirubin can lead to brain damage,
which may result in neurodevelopmental
impairment such as cerebral palsy, and visual
and hearing loss.
 Visual assessment of NNJ (Kramer's
rule)
Area of the body Level Range of serum bilirubin
µmol/L mg/dL
Head and neck 1 68-133 4-8
Upper trunk (above 2 85-204 5-12
umbilicus)
Lower trunk and 3 136-272 8-16
thighs (below
umbilicus)
Arms and lower legs 4 187-306 11-18
Palms and soles 5 306≥ 18≥
Types of Hyperbilirubinemia or NNJ
Physiological Jaundice
it having no serious consequences.
appears between 24-72 h of age
it disappears by 10-14 days of life
serum level lees than 15 mg / dl
Types of Hyperbilirubinemia or NNJ
Pathological Jaundice
Appearance of jaundice within 24 h due to the increase in
serum bilirubin beyond 5 mg/dl/day, presence of clinical
jaundice more than 2 weeks and conjugated bilirubin
Serum bilirubin > 15 mg / dl
Types of Hyperbilirubinemia
Hemolytic Jaundice
It is an isoimmunity hemolysis associated with :
Rh hemolytic disease
ABO incompatibility
Glucose-6-phosphate dehydrogenase
(G-6-PD) deficiency
minor blood group incompatibility.
Breast Feeding and Breast Milk Jaundice

Jaundice in breast fed babies usually appears

between 24-72h of age, peaks by 5-15 days of life and
disappears by the third week of life. Higher bilirubin
levels have been reported in these infants

Very large amounts of bilirubin rarely

accumulate in the blood and cause
cerebral lesions, a situation known as nuclear jaundice
Causes of Neonatal jaundice
Jaundice most often happens as a result of an
underlying disorder that either causes the
production of too much bilirubin or prevents the
liver from getting rid of it.
Both of these result in bilirubin being deposited
in tissues.
Causes of Neonatal jaundice

Appearing within 24 hours of age

Hemolytic disease, Infections, malaria,
G6PD deficiency.

Appearing between 24-72 hours of life

Physiological
Sepsis
Polycythemia
Intraventricular hemorrhage and Increased entero-hepatic circulation
Causes of Neonatal jaundice
After 72 hours of age
Sepsis Cephalohematoma
Neonatal hepatitis Extra-hepatic biliary atresia
Breast milk jaundice Metabolic disorders (G6PD).
Management of neonatal jaundice
1. Phototherapy is treatment with a special type of
(not sunlight).
Management of neonatal jaundice
There are 2 main types of phototherapy.
conventional phototherapy 
where the baby is laid under a halogen or fluorescent lamp with
their eyes covered
fibreoptic phototherapy 
where the baby lies on a blanket that incorporates fibreoptic
cables; light travels through the fibreoptic cables and shines on
to the baby's back
Management of neonatal jaundice
2. Exchange transfusion
If the baby has a very high level of
bilirubin in their blood or phototherapy
hasn't been effective, they may need a
complete blood transfusion.

the baby's blood will be removed

through a thin plastic tube placed in
blood vessels in their umbilical cord,
arms or legs.
Management of neonatal jaundice
3. intravenous immunoglobulin (IVIG)
If the jaundice is caused by rhesus disease
(when the mother has rhesus-negative blood
and the baby has rhesus-positive blood),
intravenous immunoglobulin (IVIG) may be
used.
Summary
Jaundice is a
The most If the baby's jaundice
common and
causes of doesn't improve over
usually harmless
neonatal time or tests show high
condition in
jaundice is too levels of bilirubin in
newborn babies
much bilirubin their blood, they may
that causes
or prevents the be admitted to hospital
yellowing of the
liver from and treated with
skin and the
getting rid of it. phototherapy or an
whites of the
exchange transfusion.
eyes.
1
7
Question

In Physiological Jaundice the baby…

having serious consequences
having no serious consequences

How we can Manage of neonatal jaundice?

Exchange transfusion

Supplement
REFERENCES
● Ullah, S., Rahman, K., & Hedayati, M. (2016, May).
Hyperbilirubinemia in Neonates: Types, Causes, Clinical
Examinations, Preventive Measures and Treatments: A
Narrative Review Article.

● Daniel2, O. J. (2006, January 27). Neonatal jaundice and its

management: knowledge, attitude and practice of community
health workers in Nigeria.

● (n.d.). Retrieved from

https://www.starship.org.nz/guidelines/jaundice-
management-of-neonatal-jaundice/.
THANK
S