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Jaundice in the newborn
R Agrawal1, R Aggarwal, A K Deorari
1Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Insights
Neonatal hyperbilirubinemia, or jaundice, affects 5-10% of newborns. This protocol outlines management guidelines for various infant groups, adapting American Academy of Pediatrics recommendations for Indian neonates.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Neonatal hyperbilirubinemia is a frequent complication, necessitating intervention in 5-10% of newborns.
- Physiological jaundice patterns differ between breastfed and formula-fed infants.
- Existing jaundice management guidelines require adaptation for specific infant populations and regional validation.
Purpose of the Study:
- To establish a comprehensive protocol for managing neonatal jaundice.
- To adapt American Academy of Pediatrics (AAP) guidelines for diverse neonatal subgroups.
- To address the need for validating hour-specific bilirubin charts in Indian infants.
Main Methods:
- Inclusion of established American Academy of Pediatrics (AAP) guidelines for jaundice management in term newborns.
- Development of separate guidelines for sick term infants, preterm and low birth weight babies.
- Inclusion of specific protocols for jaundice due to hemolysis and prolonged hyperbilirubinemia.
Main Results:
- A structured protocol incorporating AAP guidelines for routine neonatal jaundice management.
- Tailored management strategies for high-risk and specific neonatal populations.
- Identification of the need for regional validation of diagnostic tools like hour-specific bilirubin charts.
Conclusions:
- The protocol provides a framework for managing neonatal hyperbilirubinemia, considering various clinical scenarios.
- Adaptation of international guidelines and validation in local populations are crucial for effective jaundice management.
- Further research is needed to validate hour-specific bilirubin nomograms for Indian neonates.
Abstract:
Hyperbilirubinemia is the commonest morbidity in the neonatal period and 5-10% of all newborns require intervention for pathological jaundice. Neonates on exclusive breast-feeding have a different pattern of physiological jaundice as compared to artificially fed babies. Guidelines from American Academy of Pediatrics (AAP) for management of jaundice in a normal term newborn have been included in the protocol. Separate guidelines have been provided for the management of jaundice in sick term babies, preterm and low birth weight babies, for jaundice secondary to hemolysis and for prolonged hyperbilirubinemia. Although hour specific bilirubin charts are available, these have to be validated in Indian infants before they are accepted for widespread use.