2. 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

3. HYPERBILIRUBINEMIA

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

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

6. 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

7. HYPERBILIRUBINEMIA vs Pathologic Jaundice if:
It appears in the first 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 days of life
Direct reacting bilirubin is >2 mg/dL
With signs of kernicterus

8. HYPERBILIRUBINEMIA ABO incompatibility
15% of live births are at risk but manifestations of disease develop in %
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

9. HYPERBILIRUBINEMIA
Low risk >= 38 wks and well Medium risk >= 38wks+risk factors or
High risk /7 + risk factor /7 wks and well

10. 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

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

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

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

14. 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