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Ictericia neonatal 469
4. Enfermedad hemolítica Rh:
– Pronóstico >20 mg/dl.
– Velocidad de ascenso > 1 mg/hora con fototerapia.
– Velocidad de ascenso > 0,5 mg/hora con fototerapia si anemia.
Complicaciones
• Hipocalcemia/hipomagnesemia.
• Hipoglucemia.
• Alcalosis metabólica/acidosis.
• Hiperpotasemia.
• Hipotermia.
CRITERIOS DE INGRESO PARA ESTUDIO Y TRATAMIENTO
Se ingresarán todos los RN con ictericia que precisen estudio y/o necesidad de
tratamiento:
• Isoinmunización.
• Ictericia en las primeras 24 horas.
• Pretérminos.
• Hiperbilirrubinemia directa > 2 mg/dl o > 15% de la BRB total.
• Deshidratación.
• Signos de enfermedad grave subyacente.
BIBLIOGRAFÍA
1. American Academy of Pediatrics. Management of hyperbilirrubinemia in the newborn infant 35 or
more weeks of gestation. Pediatrics 2004 Jul;114(1):297-316 [Erratum in: Pediatrics. 2004
Oct;114(4):1138].
2. Bhutani V.K et al.Jaundice technologies:prediction of hyperbilirrubinemia in terms and near-term new-
borns. J Perinatol 2001; 21 (Suppl 1):S76-S82.
3. Bhutani V.K et al. Pedictive ability of a predischarge hour-especific serum bilirrubinfor subsequent sig-
nificant hyperbilirrubinemia in healthy term and neae-term newborns. Pediatrics 1999;103:6-14.
4. Dennery P.A. et al. Neonatal hyperbilirrubinemia. N England J Med 2001;334:581-590.
5. Escobar GJ et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gesta-
tions.Arch Dis Child 2005 Feb;90(2):125-31.
6. Gourly G.R. Breastfeeding, diet and hyperbilirrubinemia. Neoreviews 2000;1:e25-e30.
7. Gourly G.R. et al.A controlled, randomized, double-blind trial of prophylaxis against jaundice among
breastfed newborns. Pediatrics 2005 Aug;116(2):385-91.
8. Makay B et al. Randomized, controlled trial of early intravenous nutrition for prevention of neonatal
jaundice in term and near-term neonates. J Pediatr Gastroenterol Nutr 2007 Mar;44(3):354-8.
9. Martínez JC et al. Hyperbilirrubinemia in the breastfed newborn: a controlled trial of four interven-
tions. Pediatric 1993; 91:470-473.
10. Peteresc SM. Management of neonatal Rh disease. Clin Perinatol 1995; 22: 561-592.
11. Stevenson DK et al.Prediction of hypeerbilirrubinemia in near-term and terms infants.Pediatrics 2001;
108:31-39.
12. Watchko JF et al.Kernicterus in preterms newborns:past,present,and future.Pediatrics 1992;90:707-
715.
Ictericia neonatal 469
4. Enfermedad hemolítica Rh:
– Pronóstico >20 mg/dl.
– Velocidad de ascenso > 1 mg/hora con fototerapia.
– Velocidad de ascenso > 0,5 mg/hora con fototerapia si anemia.
Complicaciones
• Hipocalcemia/hipomagnesemia.
• Hipoglucemia.
• Alcalosis metabólica/acidosis.
• Hiperpotasemia.
• Hipotermia.
CRITERIOS DE INGRESO PARA ESTUDIO Y TRATAMIENTO
Se ingresarán todos los RN con ictericia que precisen estudio y/o necesidad de
tratamiento:
• Isoinmunización.
• Ictericia en las primeras 24 horas.
• Pretérminos.
• Hiperbilirrubinemia directa > 2 mg/dl o > 15% de la BRB total.
• Deshidratación.
• Signos de enfermedad grave subyacente.
BIBLIOGRAFÍA
1. American Academy of Pediatrics. Management of hyperbilirrubinemia in the newborn infant 35 or
more weeks of gestation. Pediatrics 2004 Jul;114(1):297-316 [Erratum in: Pediatrics. 2004
Oct;114(4):1138].
2. Bhutani V.K et al.Jaundice technologies:prediction of hyperbilirrubinemia in terms and near-term new-
borns. J Perinatol 2001; 21 (Suppl 1):S76-S82.
3. Bhutani V.K et al. Pedictive ability of a predischarge hour-especific serum bilirrubinfor subsequent sig-
nificant hyperbilirrubinemia in healthy term and neae-term newborns. Pediatrics 1999;103:6-14.
4. Dennery P.A. et al. Neonatal hyperbilirrubinemia. N England J Med 2001;334:581-590.
5. Escobar GJ et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gesta-
tions.Arch Dis Child 2005 Feb;90(2):125-31.
6. Gourly G.R. Breastfeeding, diet and hyperbilirrubinemia. Neoreviews 2000;1:e25-e30.
7. Gourly G.R. et al.A controlled, randomized, double-blind trial of prophylaxis against jaundice among
breastfed newborns. Pediatrics 2005 Aug;116(2):385-91.
8. Makay B et al. Randomized, controlled trial of early intravenous nutrition for prevention of neonatal
jaundice in term and near-term neonates. J Pediatr Gastroenterol Nutr 2007 Mar;44(3):354-8.
9. Martínez JC et al. Hyperbilirrubinemia in the breastfed newborn: a controlled trial of four interven-
tions. Pediatric 1993; 91:470-473.
10. Peteresc SM. Management of neonatal Rh disease. Clin Perinatol 1995; 22: 561-592.
11. Stevenson DK et al.Prediction of hypeerbilirrubinemia in near-term and terms infants.Pediatrics 2001;
108:31-39.
12. Watchko JF et al.Kernicterus in preterms newborns:past,present,and future.Pediatrics 1992;90:707-
715.
