HYPERBILIRUBINEMIA Risk Factors TSB in high risk zone Jaundice observed in the first 24 hr Blood group incompatibility or with hemolytic disease (G6PD) Gestational age 35-36wks Previous sibling received phototherapy Cephalhematoma or significant bruising Exclusive breastfeeding East asian race

HYPERBILIRUBINEMIA

HYPERBILIRUBINEMIA Causes Unconjugated hyperbilirubinemia Increased production Decreased conjugation Competitive blockage of transferase enzyme Increased enterohepatic recirculation

HYPERBILIRUBINEMIA Causes Conjugated hyperbilirubinemia Decreased excretion by damaged hepatic parenchymal cells Diseases of biliary tract

HYPERBILIRUBINEMIA Physiologic Jaundice Jaundice at 2nd – 3rd day of life Result of increased bilirubin production from the breakdown of fetal RBC combined with transient limitation in the conjugation due to immature liver Decreases between 5th - 7th day of life

HYPERBILIRUBINEMIA vs Pathologic Jaundice if: It appears in the first 24-36 hrs of life Serum bilirubin is rising at a rate faster than 5mg/dL/24hr Serum bilirubin is >12mg/dL in FT or 10-14mg/dL in PT Jaundice persists after 10-14 days of life Direct reacting bilirubin is >2 mg/dL With signs of kernicterus

HYPERBILIRUBINEMIA ABO incompatibility 15% of live births are at risk but manifestations of disease develop in 0.3-2.2% Mother is type O while baby is A or B Results from the presence of IgG antibodies against type A or B that can cross the placenta Dx: ABO incompatibility, positive Coomb’s test

HYPERBILIRUBINEMIA Low risk >= 38 wks and well Medium risk >= 38wks+risk factors or High risk 35-37 6/7 + risk factor 35-36 6/7 wks and well

NEONATAL SEPSIS Incidence: 1-4% in preterm, <1% in term infants Risk Factors: Premature labor Prolonged rupture of fetal membranesmonoc Low birth weight Chorioamnionitis Maternal fever

NEONATAL SEPSIS Etiology Gram (+) cocci – Group B beta hemolytic strep, S. aureus, S. epidemidis Gram (-) cocci- E. coli, Klebsiella pneumoniae Gram (+) rods – Listeria monocytogenes

NEONATAL SEPSIS Signs and Symptoms Unexplained respiratory distress Unexplained feeding intolerance Temperature instability Hypo/hyperglycemia Apnea Lethargy Irritability

NEONATAL SEPSIS Sepsis Work up CBC Blood culture Lumbar puncture Urinalysis Chest xray

NEONATAL SEPSIS Treatment Empiric : penicillin + aminoglycoside, change antibiotic according to the result of culture Nosocomial: antibiotics should depend on nursery exposure information Duration: 7-10 days except for invasive infections i.e. osteomyelitis