Ada 2 artikel tentang jaundice.. yang satu dari mayoclinic.. satu lagi dari kidshealth....
coba saya highlight-kan untuk masalah pengobatan/treatment-nya: * pada dasarnya jaundice itu bukan penyakit, lebih karena fungsi liver/hati belum berfungsi dengan baik dalam proses metabolisme tubuh. * mild jaundice dapat hilang dengan sendirinya pada minggu 1 dan minggu kedua. * moderate/severe jaundice --> tinggal lebih lama di rs. * Treatment: a, fototerapi b. IVIg Treatment --> kalo goldarah bayi + ibu berbeda c. transfusi * kalo jaundice-nya mild/severe -> dapat hilang dengan sendirinya dengan pemberian/frekuensi minum/asi lebih sering > batasan bilirubin dan umur bayi : > > 24 - 48 hrs: > PT considered: TBS > 12 mg/dl > PT: TSB > 15 mg/dl; > > 49 - 72 hrs: > PT considered: PT > 15 mg/dl > PT: TBS 18 mg/dl; > > > 72 hrs: > PT considered: TSB > 17 mg/dl > PT: TSB > 20 mg/dl; > > PT (phototerapy - disinar) > Baris pertama (yang ada hrs) : adalah menunjukkan umur bayi ketika pertama kali dideteksi mengalami kuning. Jadi semakin lama umur bayi baru kuning kelihatan maka kadar bilirubin yang dapat ditoleransi si tubuh bayi juga makin tinggi. Baris kedua dan ketiga adalah menunjukkan pada kadar berapa si bilirubin itu phototerapy (PT) mulai dipertimbangkan atau mulai diberikan. kalo masih dipertimbangkan itu bisa kemudian dilaksanakan atau bisa juga tidak. **** ============= Original Article: http://www.mayoclinic.com/invoke.cfm?id=DS00107 Jaundice in newborns Overview In their first few days of life, more than half of all full-term babies and as many as four out of five premature infants who are otherwise healthy develop jaundice, a yellowish discoloration of the skin and eyes. Although some babies are jaundiced at birth, most develop the condition during their second or third day of life. That's why you may not notice it until after your baby is home. Jaundice itself isn't a disease. In most cases it occurs because your baby's liver isn't mature enough to metabolize a molecule called bilirubin, which normally forms when the body recycles old or damaged red blood cells. Jaundice usually isn't a cause for alarm. It doesn't cause discomfort for your baby, and it usually disappears on its own in one to two weeks. Still, it should be closely monitored by your baby's doctor because severe jaundice can lead to serious complications. Treatments can help keep your baby's blood level of bilirubin from becoming too high. Signs and symptoms In most babies, signs and symptoms of jaundice appear in the second or third day of life and include: Yellowing of the skin Yellowing of the eyes Lethargy, in some cases You'll usually notice jaundice first in your baby's face. Later, his or her chest, stomach and legs also may turn yellow. An easy way to test for jaundice in newborns of any race is to gently press your finger on your baby's forehead or nose. If the skin looks yellow where you pressed, it's likely your baby has jaundice. It's best to examine your baby in natural daylight. In addition to checking for yellow skin, note whether the whites of your baby's eyes also are yellow. Jaundice commonly lasts for a week to 10 days in full-term newborns. If your baby is premature or if you breast-feed your baby, jaundice may last longer. Causes Babies are born with a generous supply of red blood cells, which help transport oxygen. Over time, these red blood cells break down, forming bilirubin in the process. Bilirubin is normally transported to the liver where it's processed before being eliminated from the body. But newborns initially have more bilirubin than their livers can handle, and the excess causes their skin, and sometimes the whites of their eyes, to turn yellow. This type of jaundice, called physiologic jaundice, typically appears on the second or third day of life. Although any newborn can develop physiologic jaundice, it occurs more often, and is sometimes more severe, in premature babies because their livers are even less developed than are those of full-term infants. Sometimes a baby may develop jaundice for other reasons. If jaundice is present at birth or appears within 24 hours, it may be the result of: Severe bruising An infection in your baby's blood (sepsis) An incompatibility between your blood and your baby's Jaundice that develops in or lasts past the second week of life may be due to: A liver malfunction A severe infection An enzyme deficiency An abnormality of your baby's red blood cells Risk factors Boy babies tend to be at higher risk of jaundice than are girls. Asian and American Indian infants also are more likely to have jaundice. Other factors that may put your newborn at risk of jaundice include: Premature birth. Because your premature baby may not be able to process bilirubin as quickly as full-term babies do, he or she is at higher risk of jaundice. Your preemie may also feed less at first and have fewer bowel movements, which means less bilirubin is likely to be eliminated in your baby's stool. Bruising during birth. Sometimes babies are bruised during birth. If your newborn has a bruise, he or she may have a higher level of bilirubin from the breakdown of more red blood cells. Blood type. If your blood type is different from your baby's, your baby may have received antibodies through the placenta that cause his or her blood cells to break down more quickly. Blood groups are determined according to whether you have certain protein molecules on the surface of your blood cells. The rhesus (Rh) factor is one of these blood groups. If you have the Rh factor in your blood cells, you're considered Rh positive. If you don't, you're Rh negative. There's nothing inherently wrong with being either Rh positive or Rh negative. But problems can arise when an Rh-negative woman is pregnant with an Rh-positive baby. During pregnancy, fetal cells cross the placental barrier and mix with the mother's cells. If the mother's immune system detects the baby's opposing Rh factor, it produces antibodies against it. These antibodies then attach to the baby's red blood cells, causing them to break apart and release bilirubin. To minimize the likelihood of problems, Rh-negative women receive injections of Rh-o (D) immune globulin (RhoGAM), which prevents the mother's body from producing unwanted antibodies, during the pregnancy and immediately following birth. Breast-feeding. Breast-fed babies have a higher risk of jaundice, but for most newborns the risk is slight and is far outweighed by the benefits of breast-feeding. In addition, if a mother's milk is slow to let down, her baby may not gain weight as readily, which makes jaundice more pronounced. Breast-feeding more than the daily usual of eight to 10 times, which will encourage your baby to have more bowel movements, might reduce the risk. Breast-milk-related jaundice normally appears four to seven days after birth and may last for several weeks. Early discharge from the hospital. Because bilirubin levels tend to rise during the second and third days of life, babies who are released from the hospital less than 72 hours after birth are at increased risk of developing jaundice after they're home. Before early discharges were common, jaundice was usually recognized and treated in the hospital nursery. When to seek medical advice During the first few days after your baby goes home, be alert for the development of jaundice. Call or see your baby's doctor if your newborn develops jaundice or begins to look or act sick. Be sure to check with your baby's doctor if your newborn's jaundice is severe: If the skin is bright yellow If it lasts longer than one or two weeks If your baby isn't gaining weight If your baby develops any other symptoms that concern you If your baby was born at 36 to 38 weeks gestational age ? several weeks early ? be particularly careful to watch for the development of jaundice or poor feeding. Babies born in this age range have a higher likelihood of needing medical treatment for jaundice after their discharge from the hospital. Arrange with your doctor to have the baby's weight checked within several days after going home. This makes it easy to monitor both weight gain and jaundice. Don't hesitate to ask about having your baby's weight checked: It's easy, quick to do and reassuring. Screening and diagnosis Your doctor will likely diagnose jaundice on the basis of your baby's appearance. He or she may also take a small sample of your baby's blood to measure the bilirubin level. A device that measures bilirubin through the skin (transcutaneous bilirubinometer) may be useful in screening newborns for jaundice. The device measures the reflection of a special light shone through the skin and eliminates the need to take a blood sample. Your baby may have additional blood tests if the jaundice requires treatment or if you and your baby have different blood types. Complications When bilirubin reaches extremely high levels, especially in newborns ill enough to require treatment in a newborn intensive care unit, it can lead to a rare, but very serious, condition called kernicterus. This disorder causes damage to a newborn's brain, and may lead to deafness, severe developmental disabilities and an unusual form of cerebral palsy. Especially if your baby was born early, be watchful for signs and symptoms of severe jaundice, such as: Deep yellow or orange skin tones Extreme sleepiness so that it's hard to wake your baby High-pitched crying Poor sucking or nursing Weakness or limpness Treatment Mild jaundice in newborns often disappears on its own within a week or two. But if your baby has moderate or severe jaundice, he or she may need to stay longer in the newborn nursery or be readmitted to the hospital. Treatments to lower the level of bilirubin in your baby's blood may include: Light therapy (phototherapy). Your baby may be placed under a special ultraviolet light or wrapped in a fiber-optic blanket of light. The light changes the bilirubin into a form that can be eliminated by your baby's kidneys. Newborns with jaundice typically receive phototherapy for several days. Intravenous immunoglobulin (IVIg). If moderate to severe jaundice develops because of blood group differences between mother and baby, an intravenous transfusion of antibodies may decrease the jaundice and lessen the need for exchange blood transfusion. Exchange blood transfusion. In extremely rare cases, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood, "diluting out" the bilirubin and maternal antibodies, and then transferring the blood back into the baby ? a procedure that's performed in a newborn intensive care unit. Self-care When jaundice isn't severe, the following may help lower your newborn's bilirubin level: More frequent feedings. Feeding more frequently will provide your baby with more calories and cause more bowel movements, increasing the amount of bilirubin passed in your baby's stool. Formula milk. Temporarily supplementing breast milk with formula or changing to formula, even for only one or two days, may quickly lower your baby's bilirubin level. You can use a breast pump to express your milk until you start breast-feeding again. Some doctors hesitate to suggest this approach, however, because they don't want to interfere with your efforts to breast-feed your baby. Another option is to "top off" the breast-feeding by offering an ounce or two of formula at the end of each breast-feeding for a week. By Mayo Clinic staff DS00107 April 14, 2005 © 1998-2005 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research. ***** http://www.kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=20049&article_set=21690 Jaundice in Healthy Newborns A common condition in newborns, jaundice refers to the yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood. Bilirubin is produced by the normal breakdown of red blood cells. Normally bilirubin passes through the liver and is excreted as bile through the intestines. Jaundice occurs when bilirubin builds up faster than a newborn's liver can break it down and pass it from the body. Reasons for this include: A newborn baby's still-developing liver may not yet be able to remove adequate bilirubin from the blood. More bilirubin is being made than the infant's liver can handle. Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool. High levels of bilirubin - usually above 20 mg - can cause deafness, cerebral palsy, or brain damage in some babies. In rare cases, jaundice may indicate the presence of hepatitis. The American Academy of Pediatrics recommends that all infants should be examined for jaundice within a few days after being born. Types of Jaundice There are several types of newborn jaundice. The following are the most common: Physiological (normal) jaundice: occurring in more than 50% of newborns, this jaundice is due to the immaturity of the baby's liver, which leads to a slow processing of bilirubin. It generally appears at 2 to 4 days of age and disappears by 1 to 2 weeks of age. Jaundice of prematurity: this occurs frequently in premature babies since they take longer to adjust to excreting bilirubin effectively. Breast milk jaundice: in 1% to 2% of breastfed babies, jaundice can be caused by substances produced in their mother's breast milk that can cause the bilirubin level to rise above 20 mg. These substances can prevent the excretion of bilirubin through the intestines. It starts at 4 to 7 days and normally lasts from 3 to 10 weeks. Blood group incompatibility (Rh or ABO problems): if a baby has a different blood type than the mother, the mother might produce antibodies that destroy the infant's red blood cells. This creates a sudden buildup of bilirubin in the baby's blood. Incompatibility jaundice usually begins during the first day of life. Rh problems once caused the most severe form of jaundice, but now can be prevented with an injection of Rh immune globulin to the mother within 72 hours after delivery, which prevents her from forming antibodies that might endanger any subsequent babies. Symptoms and Diagnosis Jaundice usually appears around the second or third day of life. It begins at the head and progresses downward. A jaundiced baby's skin will appear yellow first on the face, followed by the chest and stomach, and finally, the legs. It can also cause the whites of an infant's eyes to appear yellow. Since many babies are now released from the hospital at 1 or 2 days of life, parents should keep an eye on their infants to detect jaundice. A simple test for jaundice is to gently press your fingertip on the tip of your child's nose or forehead. If the skin shows white (this test works for all races) there is no jaundice; if it shows a yellowish color, you should contact your child's doctor to see if significant jaundice is present. At the doctor's office, a small sample of your infant's blood can be tested to measure the bilirubin level. The seriousness of the jaundice will vary based on your child's age and the presence of other medical conditions. When to Call Your Child's Doctor Your child's doctor should be called immediately if jaundice is noted during the first 24 hours of life, the jaundice involves arms or legs, your baby develops a fever over 100 degrees Fahrenheit (37.8 degrees Celsius), or if your child starts to look or act sick. (In children under age 5, temperatures should be taken rectally or aurally.) Call your child's doctor if the color deepens after day 7, the jaundice is not gone after day 15, your baby is not gaining sufficient weight, or if you are concerned about the amount of jaundice in your baby's skin. Treatments In mild or moderate levels of jaundice, by 5 to 7 days of age the baby will take care of the excess bilirubin on its own. If high levels of jaundice do not clear up, phototherapy - ultraviolet light that helps rid the body of the bilirubin by altering it or making it easier for your baby's liver to get rid of it - may be prescribed. More frequent feedings of breast milk or formula to help infants pass the bilirubin in their stools may also be recommended. In rare cases, a blood exchange may be required to give a baby fresh blood and remove the bilirubin. If your baby develops jaundice that lasts more than a week, your doctor may ask you to temporarily stop breastfeeding. During this time, you can pump your breasts so you can keep producing breast milk and you can start nursing again once the condition has cleared. If the amount of bilirubin is high, your baby may be readmitted to the hospital for treatment. Once the bilirubin level drops, however, it is unlikely it will increase again. Updated and reviewed by: Steven Dowshen, MD Date reviewed: April 2005 Originally reviewed by: Steve Dowshen, MD, and Roy Prouj -- rgds, Lita
