This is useful in deciding whether or not aīaby needs to have the SBR measured. Jaundice starts on the head, and extends towards the feet as the level rises. Kramer drew attention to the observation that Rather than estimating the level of jaundice by simply observing theīaby's skin colour, one can utilise the cephalocaudal progression of jaundice. 3 If the feet or hands are visibly yellow, the TSB is likely to be above 250 micromol/L. The jaundice also progresses caudally from the face with a progression to the trunk and extremities, following Kramer�s.The underlying skin colour changes from a lemon yellow to a deeper orange yellow.Two clinical features of increasing severity of neonatal jaundice dominate the visual assessment: 1,2Īlways assess jaundice in good light by blanching the baby�s skin with a finger and observing the underlying skin colour. In the first 4 days of life, specifically those at risk of developing hyperbilirubinaemia during the neonatal period.Īssessments should be at least 8 to 12 hourly in the first 48 hours of life. All babies should have ongoing assessments Visual assessment remains the mainstay of jaundice surveillance in the newborn. TSB can then be used to determine need for treatment.Ĭlinical Visual Assessment of Severity of Jaundice Surveillance for neonatal jaundice involves the use of regular visual assessment of skin colour and (where availableĪnd in babies born after 35 weeks) transcutaneous bilirubin measurement (TcB) to identify babies who need total serumīilirubin measurement (TSB). They are more at risk than term infants for the same SBR level. The late effects of moderate levels of jaundice on extremely preterm infants is unknown, although it is generally accepted drugs which displace bilirubin from albumin (esp.Once a baby develops severe jaundice, the risk of progressing to kernicterus is increased by the following: These include sensorineural hearing impairment and cerebral palsy, often with At autopsy, such babies display evidence of bilirubin staining of the basal gangia. This clinical syndrome includes hypertonia progressing to opthistotonia, Kernicterus (bilirubin encephalopathy).Preterm babies - depends on gestational age - see below.Babies with haemolytic jaundice - see jaundice - haemolytic.Definition of severe jaundice depends on the clinical setting:.Inherited deficiency of glucuronyl transferase enzymes - very rareįactors likely to make physiological jaundice worse in a given baby include:.G6PD deficiency - especially post discharge home.Haemolytic jaundice (Rhesus, ABO, others). It is clinically useful to classify jaundice according to the age of the baby when he/she becomes visibly jaundiced. There are important cues that jaundice may be pathological. The clinical challenge is identifying the tiny minority with pathological neonatal jaundice from the large majority Rare complication of acute bilirubin encephalopathy and kernicterus. Because of this, it is important to identify those babies at risk of the Injury and life long disability can result. Physiological jaundice is usually benign, however if unconjugated serum bilirubin levels get too high, bilirubin canĬross the blood brain barrier where it is neurotoxic, particularly to the auditory nerve and basal ganglia. These babies have so-called �physiological jaundice�, which typically becomes clinically apparent on day 3, peaks on Approximately 60% of term babies and 85% of preterm babies will develop clinically apparent jaundice.
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