Jaundice

1. .In case of premature infant rate of maturation of liver function is slower. There is increased number of erythrocytes due to circulatory insufficiency so this way cells are hemolyze and load of bilirubin increases.
2. .Bilirubin produced as a result of break down of red blood cells at normal rate.
3. Metabolic factor
4. Mixed hemolytic and hepatotoxic disease
5. Physiological immaturity of liver during the first few day.
   
   Jaundice in newborn baby can be estimated by observing color change in the body. If color change limit is upto head and neck the bilirubin level is 6mg/dl, if it is over upper trunk average level is 9mg/dl, if over lower trunk and thigh 12 mg/dl, over legs below knees 15 mg/dl and over hands and feet then it is more than 15mg/dl.
   The infant or newborn develop sever jaundice soon after birth due to increased bilirubin load or incapacity of liver to deal with it.

• Pathological Jaundice in neonates:-
  
  Neonatal jaundice occur due to isoimmunization of the fetus and newborn infant. In most cases it is due to incapability of blood group of RH or ABO between the mother and fetus. Any physical or tension during pregnancy transfer some fetal cell to mother.
  The new term cause is kernicterus this is cause due to nuclear staining with bilirubin. The main criteria is to decrease the level of bilirubin up to normal level which cause kernicterus is Phototheraphy.
  
  1.Phototheraphy is used for jaundice. It is photo isomerization of bilirubin. In this water souble polar isomers are used. Blue light is more effective .But there are some side effect of Phototherapy is
        i)Dehydration
        ii) Bonzing of skin
        iii)Retinal damage (if eyes are not protected)
  Infants should take fluid and calories oral feeding enhance intestinal motility.
  
  2.exchange transfusion is also one way to decrease level of bilirubin. It remove the sensitized red cells from circulation. If bilirubin level is above 25-28mg/dl then exchange transfusion is required.