2. Neonatal Hemolytic Jaundice

3. Hyperbilirubinemia ( severe jaundice ) is the most common condition requiring re-hospitalization during the first week of life.
Total Serum Bil (TSB) > 17 mg/dl ≈ 10%
Total Serum Bil (TSB) > 20 mg/dl ≈ 1.5%

4. Most neonates with extreme hyperbilirubinemia have no underlying etiology.
55% to 66% of neonates with a TSB >30 mg/dl have no etiology (idiopathic jaundice), according to 2 studies.

5. Hyperbilirubinemia = bilirubin production - bilirubin elimination
Low activity of UGT1A1 ≈ 1% in newborns (diminished conjugation in all newborns)
Prodominant factor in severe jaundice is increased bilirubin production (hemolysis)

6. Increased risk of neurotoxicity
Why hemolytic jaundice is important?
Increased risk of neurotoxicity

7. Hemolytic jaundice is likely when:
jaundice observed in first 24 hours
pre-discharge Bil in high risk zone
rising Bil more than 0.5 mg/dl/h
cord Bil more than 4 mg/dl
prolonged hyperbilirubinemia
low hemoglobin ( < 13 g/dl)
positive direct anti-globulin test (DAT)
Elevated reticulocyte count

8. Hemolytic jaundice is likely when:
hepatosplenomegaly
finding hemoglobin without erythrocytes in urine
pink serum on a visual examination of a blood sample
absence of haptoglobin in the serum

10. ABO hemolytic disease
Indirect hyperbilirubinemia during the first 24h of life
Mother with blood group O, infant with blood group A or B
Spherocytosis on blood smear
Increased reticulocyte count
Evidence of hemolysis based on increased endogenous production of CO
Direct or indirect coombs positive

11. Incompatibility to other RBC antigens
Anti -c
Anti -E
Anti-Kell

16. Five diagnostic tests or approaches useful in hemolytic jaundice
Erythrocyte morphology
End-tidal carbon monoxide (ETCO) measurement
EMA flow cytometry for HS and other membrane defects
NGS (Next Generation Sequencing) of relevant genes
An algorythm in judicious use of standard tests

29. Prediction of Hemolytic Jaundice
Cord bilirubin
Clincal risk factors
Hour-specific bilirubin nomogram

30. Hour-specific Bilirubin Nomogram

31. Treatment
Phototherapy
Exchange transfusion
IVIG

32. Guidelines for Exchange Transfusion