Systemic Approach to Management of Neonatal Jaundice and Prevention of Kernicterus

Abstract

Neonatal jaundice is a yellowing of the skin and other tissues of a newborn infant. A bilirubin level of more than 85 μmol/l (5 mg/dL) manifests clinical jaundice in neonates whereas in adults alIevel of 34 μmol/l (2 mg/dL) would look icteric. Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. In cases of isoimmune haemolysis high-dose immunoglobulin is indicated if the serum bilirubin is continuing to rise despite multiple phototherapy. For babies with prolonged jaundice investigation should be directed towards making a timely diagnosis and avoiding secondary complications. Kernicterus is a bilirubin-induced brain dysfunction. Bilirubin is a highly neurotoxic substance that may become elevated in the serum, a condition known as hyperbilirubinemia. Hyperbilirubinemia may cause bilirubin to accumulate in the gray matter of the central nervous system, potentially causing irreversible neurological damage. Depending on the level of exposure, the effects range from clinically unnoticeable to severe brain damage and even death. Neonates are especially vulnerable to hyperbilirubinemia-induced neurological damage and therefore must be carefully monitored for alterations in their serum bilirubin levels.