jaundice ( indirect hyper Bilirubin )

at 1st 72 hrs of life :-baby with TSB more than 25 mg/dl / 38wks of gestation Rx------------------------------------------------------------------------------------------------------------------ 1-blood + cross match . 2-Exchange transfusion 3-intensive photo therapy. 4- (2-3hr need to monitoring TSB =>Still more 20-25 mg/dl=>repeat in (3-4hrs)=>reduce to 20mg/dl =>repeat in (4-6hrs) =>fall =>repeat in (8-12hrs) =>TSB <13-14mg/dl ==>DISCONTINUE PHOTO-THERAPY. 5-after (24 hrs) measurement TSB 6- WHEN EVER DETECT KERNICTERUS SIGNS ==> EMERGENCY ROOM

If case with infant who suffer from isoimmune hemolytic disease + TSB rising Rx-------------------------------------------------------------------------------------------------------- 0- exchange transfusion if sever risk ! anemia /hyper-bilirubin TSB >5 mg/dl , Hb <10 mg 1-intensive photo-therapy 2-IVIG 0.5-1g/kg over 2hrs & repeat 12 hr IF NECESSARY. 3- use TOTAL BILIRUBIN don't subtract direct (conjugated )bilirubin. IF unusual situation Direct bilirubin level equal or more 50% than total bilirubin NEED consultation with an expert pediatric gastro-enterologist. 4- some physicain refer to ER if Retic count >15 % previous K or erythroblastosis rapidly increase TSB & prematurity

IN CASE OF PREMATURE INFANT less than 35 wks of gestation THE therapy will depending on :- 1-GA . 2-INFANT CONDITION. 3-RISK FACTOR TO DEVELPED KERNICTEURES AT LOWER LEVEL. Rx------------------------------------------------------------------------------------------------------------------------ 1-photo-therapy 2-Exchange -transfusion

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	Created by Ali Almudarsy about 6 years ago