Hyper-bilirubinaemia can be treated
with:
with:
i.
Phototherapy
Phototherapy
ii.
Exchange transfusion
Exchange transfusion
iii.
Pharmacological agents
Pharmacological agents
Phototherapy:
This
is when the baby is subjected to light of a certain wavelength (450nm). At this
wave length, it converts non-conjugated bilirubin into a harmless substance and
decrease bilirubin level; it oxidized the bilirubin to biliverdin, a soluble
product that does not contribute to kernicterus. Physicians randomly assigned
66 infants 35 weeks of gestation to receive phototherapy. After 15±5 the level
of bilirubin, a yellowish bile pigment that in excessive amount causes
jaundice, were decrease down to 0.27±0.25mg/dl/h in the blue light. This
suggests that blue light therapy helps reduce high bilirubin level that causes
neonatal jaundice.
is when the baby is subjected to light of a certain wavelength (450nm). At this
wave length, it converts non-conjugated bilirubin into a harmless substance and
decrease bilirubin level; it oxidized the bilirubin to biliverdin, a soluble
product that does not contribute to kernicterus. Physicians randomly assigned
66 infants 35 weeks of gestation to receive phototherapy. After 15±5 the level
of bilirubin, a yellowish bile pigment that in excessive amount causes
jaundice, were decrease down to 0.27±0.25mg/dl/h in the blue light. This
suggests that blue light therapy helps reduce high bilirubin level that causes
neonatal jaundice.
Exposing
infants to high level of coloured light changes trans-bilirubin to the more
water soluble cis-form which is excreted in the bile. This works through a
process of isomerisation. In phototherapy, blue light is typically used because
it is more effective at breaking down bilirubin. Two matched groups of newborn
infants with jaundice were exposed to intensive green or blue light
phototherapy.
infants to high level of coloured light changes trans-bilirubin to the more
water soluble cis-form which is excreted in the bile. This works through a
process of isomerisation. In phototherapy, blue light is typically used because
it is more effective at breaking down bilirubin. Two matched groups of newborn
infants with jaundice were exposed to intensive green or blue light
phototherapy.
The
efficiency of the treatment was measured by the rate of decline of serum
bilirubin, which in excessive amounts causes jaundice, concentration after 6,
12 and 24 hours of light exposure. A more rapid response was obtained using the
blue lamps than the green lamp. However, a shorter phototherapy recovery period
was noticed in babies exposed to the green lamps. Green light is not commonly
used because exposure time overhead lamps, which means that the baby’s need to
be covered, or with a device called a biliblanket, which sits under the baby’s
clothing close to its skin. (Stokowski, 2006).
efficiency of the treatment was measured by the rate of decline of serum
bilirubin, which in excessive amounts causes jaundice, concentration after 6,
12 and 24 hours of light exposure. A more rapid response was obtained using the
blue lamps than the green lamp. However, a shorter phototherapy recovery period
was noticed in babies exposed to the green lamps. Green light is not commonly
used because exposure time overhead lamps, which means that the baby’s need to
be covered, or with a device called a biliblanket, which sits under the baby’s
clothing close to its skin. (Stokowski, 2006).
Exchange Transfusion
An
exchange transfusion requires that the patient’s blood can be removed and
replaced. In most cases, this involves placing one or more thin tubes, called
catheters into a blood vessel. This exchange transfusion is done in cycles;
each one usually last a few minutes. The patient’s blood is slowly withdrawn
and a slightly larger amount of fresh, prewarmed blood or plasma flows into the
patient’s body. This cycle is repeated until the correct volume of blood has
been replaced. In conditions such as neonatal polycythemia, a specific amount
of the child’s blood is removed and replaced with a normal saline solution,
plasma or albumin. This decreases the total number of red blood cells in the
body and makes it easier for blood to flow through the body.
exchange transfusion requires that the patient’s blood can be removed and
replaced. In most cases, this involves placing one or more thin tubes, called
catheters into a blood vessel. This exchange transfusion is done in cycles;
each one usually last a few minutes. The patient’s blood is slowly withdrawn
and a slightly larger amount of fresh, prewarmed blood or plasma flows into the
patient’s body. This cycle is repeated until the correct volume of blood has
been replaced. In conditions such as neonatal polycythemia, a specific amount
of the child’s blood is removed and replaced with a normal saline solution,
plasma or albumin. This decreases the total number of red blood cells in the
body and makes it easier for blood to flow through the body.
Immediate
exchange transfusion is recommended if the total serum bilirubin is greater
than 428μmol/l and if a baby is jaundice and displays signs of immediate to
advanced stages of acute bilirubin encephalopathy which include lethargy, poor
feeding with high pitched cry, arching, apnoea, seizures etc.
exchange transfusion is recommended if the total serum bilirubin is greater
than 428μmol/l and if a baby is jaundice and displays signs of immediate to
advanced stages of acute bilirubin encephalopathy which include lethargy, poor
feeding with high pitched cry, arching, apnoea, seizures etc.
Adjunct Pharmacological Therapy
They
include:
include:
1. Intravenous Immunoglobulin (IVIG)
There
is some evidence that IVIG will reduce the need for exchange transfusion in
babies with rhesus haemolytic diseases and other immune haemolytic jaundice. It
reduces bilirubin concentration in babies who have predicted severe disease
base on antenatal investigation. The dose required is 1g/kg given intravenously
over 2 hours. The use of IVIG may be recommended in special circumstance such
as parental refusal for exchange transfusion and where appropriate blood
components for exchange transfusion are unavailable.
is some evidence that IVIG will reduce the need for exchange transfusion in
babies with rhesus haemolytic diseases and other immune haemolytic jaundice. It
reduces bilirubin concentration in babies who have predicted severe disease
base on antenatal investigation. The dose required is 1g/kg given intravenously
over 2 hours. The use of IVIG may be recommended in special circumstance such
as parental refusal for exchange transfusion and where appropriate blood
components for exchange transfusion are unavailable.
2. Phenobarbitone:
May
improve bile flow but is not recommended for treatment of hyper-bilirubinaemia.
improve bile flow but is not recommended for treatment of hyper-bilirubinaemia.
3. Metalloporphyrins/Tin Mesoporphorin:
Tin
mesoporphorins inhibits enzyme haemoglobin oxidase.
mesoporphorins inhibits enzyme haemoglobin oxidase.
4. Ursodeoxycholic Acid:
May
improve bile flow and lower bilirubin concentrations.
improve bile flow and lower bilirubin concentrations.
