jaundice ( indirect hyper Bilirubin )

Nodos de los diagramas

• at birth 0 day

• 1 day 

• 2 day 

• 3 day

• 4 day

• 5 day

• 6 day 

• 7 day

• 8 day

• 9 day

• 10 day

• pathological Jaundice 

• physiologicsl jaundice term 

• physiologicsl jaundice preterm

• Hemolytic diseases

• C/F :-  TSB =5mg/dl/24hrs TSB=0.5mg/dl/hrs ​​​​​​​

• TSB= not more 12 mg/dl 6-8 mg/dl 

• TSB=not more 15 mg/dl 10-12 mg/dl

• 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