Physiologic jaundice usually appears at day 2-5 and lasts about 1012 days. Breastfeeding can continue during treatment. Prompt medical attention is necessary, and blood transfusions may be required. In a proportion of infants, jaundice may become severe, progressing to acute bilirubin encephalopathy (ABE) or kernicterus with a significant risk of neonatal mortality 3, 4. Recent reports have noted its appearance in more than 80 of otherwise healthy, term newborns. Some degree of neonatal jaundice or hyperbilirubinemia is an unpreventable condition in 6080 of newborns worldwide 1,2. Statistical analysis confirmed the association between the onset of jaundice in newborns and the following parameters: gestational age, birth weight, maternal infections and other illnesses during pregnancy and premature rupture of membranes as complications during labor and the mode of delivery. The most likely cause is blood incompatibility or liver disease. Neonatal jaundice is a common phenomenon. The study included 800 infants: 198 (24.8%) of them did, and 602 (75.2%) did not suffer from jaundice. The aim of the research was to examine the incidence frequency of unconjugated pathologic jaundice in newborns and connect it to some epidemiological variations (medical, social, demographic) as well as to prove the increased frequency of jaundice in children born by stimulation and labour induction. If the concentration of non-conjugated bilirubin in the blood is too high, it breaches the blood brain barrier and bilirubin encephalopathy occurs with serious consequences for the child. Conjugated hyperbilirubinemia or chole- stasis, on the other hand, is always pathologic and refers to a direct bilirubin level greater than 2 mg/dL (34 mmol/L). In the low birthweight infant, the level is proportionately lower.Neonatal jaundice is the occurrence of elevated bilirubin levels in the blood. The specific serum level of unconjugated bilirubin that results in kernicterus is unknown, but for the term infant it has traditionally been defined as a concentration of 20 mg/dl. It is often physiological, but it is important to note that there can be pathological processes causing. When the serum level of unconjugated bilirubin exceeds the albumin binding capacity, bilirubin diffuses into the central nervous system and may result in permanent neurological damage or death (bilirubin encephalopathy with kernicterus).Ĭonjugated bilirubin is water soluble and does not diffuse into the central nervous system so it is not capable of causing kernicterus.įactors such as acidosis and hypoalbuminemia may reduce the ability of albumin to bind to conjugated bilirubin. 60 of term infants will develop early jaundice. The level of glucuronyl transferase is initially low in the newborn and any increase in the rate of bilirubin formation can overwhelm the capacity to conjugate, thus resulting in elevated bilirubin levels. Most unconjugated bilirubin is excreted in the stool, but some is reabsorbed and returned to the liver for re-conjugation (enterohepatic circulation).

In the small bowel, some of the bilirubin is hydrolyzed to yield unconjugated bilirubin and glucuronic acid. Conjugated bilirubin is secreted into the bile and enters the duodenum. Neonatal jaundice is a common event that occurs especially in the first week of birth and is one of the most common causes of hospitalisation of the term and preterm neonates in neonatal wards. Unconjugated bilirubin is bound to albumin in the plasma and transported bound to albumin to the liver and is conjugated with glucuronic acid in the hepatocytes the conjugation is catalyzed by glucuronyl transferase.

Heme is catabolized to unconjugated bilirubin in the reticuloendothelial system. Excessive bruising from birth trauma or abnormal blood collections such as in a cephalohematoma may further add to the rate of RBC destruction and bilirubin formation. The rate of neonatal RBC destruction is higher than in adults resulting in greater quantity of hemoglobin release.

In newborns, the normal hemoglobin level is 15-18 mg/dl. Red cell hemoglobin accounts for approximately 85% of all bilirubin. Bilirubin Metabolismīilirubin is a product of heme catabolism. Although neonatal hyperbilirubinemia is usually a benign and physiologic condition, very high bilirubin levels occur in certain pathologic conditions and are potentially injurious to the central nervous system. Jaundice is seen in approximately half of all newborns.

Pathological neonatal jaundice