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Paediatrics > 1: Neonatology - Jaundice > Flashcards

1: Neonatology - Jaundice Flashcards

1
Q

What causes jaundice

A

Hyperbillirubinaemia

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2
Q

What % of neonates will experience some form of jaundice

A

60

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3
Q

What time-frame does physiological neonatal jaundice occur

A

> 24h.

Usually 2-14d.

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4
Q

What are 4 causes of physiological jaundice

A
  1. Shorter RBC lifespan
  2. Hepatic Immaturity
  3. Absence Gut Flora
  4. Exclusive Breast Feeding
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5
Q

Explain hepatic immaturity

A

Unable to conjugate bilirubin for excretion leading to accumulation

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6
Q

Why may absence of gut flora cause physiological jaundice

A

Unable to eliminate bile pigment

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7
Q

Why may breast feeding cause jaundice

A

Feeding difficulties can lead to dehydration, relatively increasing bilirubin.

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8
Q

What does jaundice in first -24h always indicate

A

Pathological cause

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9
Q

What are four possible causes of jaundice within the first 24 hours

A
  1. Rhesus haemolytic disease
  2. ABO haemolytic disease
  3. Hereditary spherocytosis
  4. G6PD deficiency
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10
Q

What test can be used for rhesus haemolytic disease

A

Direct Coombs Test

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11
Q

What test can be used to detect hereditary spherocytosis

A

Fragility Test

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12
Q

Define prolonged jaundice in term infant

A

> 14d

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13
Q

Define prolonged jaundice in pre-term infant

A

> 21d

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14
Q

What are 5 causes of prolonged jaundice

A
  1. Biliary atresia
  2. Hypothyroidism
  3. Sepsis - TORCH
  4. Cystic Fibrosis
  5. Galactosaemia
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15
Q

What causes unconjugated hyperbillirubinaemia in first 24h

A

Haemolytic disease:

  • Rhesus
  • ABO
  • G6P
  • Hereditary Spherocytosis
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16
Q

What causes conjugated hyperbillirubinaemia in first 24h

A

TORCH Infection

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17
Q

What causes uncognjugated hyperbillirubinaemia in 2-14d

A
  • Physiological Jaundice

- Breast Feeding Jaundice

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18
Q

What causes unconjugated hyperbillirubinaemia >14d

A
  • Breast Milk Jaundice
  • Congenital Hypothyroid
  • TORCH
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19
Q

How will conjugated hyperbillirubinaemia present

A

Pale stools, Dark Urine

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20
Q

What causes conjugated hyperbillrubinaemia >14d

A
  • Biliary atresia

- Neonatal hepatitis

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21
Q

What are 5 risk factors for pathological jaundice

A
  1. Low birth weight
  2. Pre-mature
  3. Previous sibling affected
  4. Birth trauma
  5. Known Rhesus or ABO incompatibility
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22
Q

How will conjugated hyperbilirubinaemia present

A

Pale Stools

Dark Urine

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23
Q

What causes conjugated hyperbillirubinaemia

A

Biliary Atresia

Neonatal hepatitis

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24
Q

What does hepatomegaly and splenomegaly associated with jaundice indicate

A

It is not associated with physiological jaundice - therefore pathological cause

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25
Q

What is breast feeding jaundice

A

Infant breast feeds it can lead to dehydration. This can reduce clearance of bilirubin

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26
Q

When does breast feeding jaundice occur

A

Day 2-14

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27
Q

What is breast milk jaundice

A

Breast Milk contains B-glucoronidase. It reduces conjugation and increases absorption of billirubin causing persistent physiological jaundice

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28
Q

When does breast milk jaundice occur

A

> 14d

29
Q

When should all babies be checked for jaundice

A

Newborn Infant Physical Exam - in 72h. Or 48h if risk factors.

30
Q

What is first line investigation for jaundice babies

A

Measure Bilirubin

31
Q

When should serum bilirubin measurement be used

A

If neonate less than 24h. Or delivered less than 35W gestation.

32
Q

When should transcutaneous billrubinometer be used

A

If neonate more than 24h. Or, delivered more than 35W

33
Q

If a transcutaneous bilirubinometer shows a bilirubin of more than 250 what should be done

A

Serum bilirubin

34
Q

If a jaundice baby is less than 24h, how often should serum bilirubin be measured

A

Measure within 2h. Then monitor every 6h.

35
Q

If a jaundice baby is more than 24h, how often should serum bilirubin be measured

A

6h.

36
Q

What tests may be used to identify cause of jaundice in first 24-hours

A
  • Coombs Test

- Blood group

37
Q

If clinically indicated what other tests may be performed

A

FBC
Blood Film
G6PD enzyme levels
Blood culture

38
Q

Which gender is G6PD more likely in

A

Males

39
Q

If a conjugated billirubinaemia what may be performed and why

A

US bile duct and GB due to risk of biliary atresia

40
Q

If bile duct dilated on US what may it indicated

A

Choledochal cyst

41
Q

If bile duct is not dilated dilated on US what may be performed

A

TIBDA scan

42
Q

What defines term

A

37-40W delivery

43
Q

What defines prolonged jaundice in a term baby

A

> 14d

44
Q

What defines prolonged jaundice in a pre-term baby

A

> 21d

45
Q

What is a prolonged jaundice screen

A
  • Pale Stools/ Dark Urine
  • Bilirubin
  • FBC
  • Blood Group
  • Urine culture
  • TFTs
46
Q

What does bilirubin level determine

A

It is plotted on a graph against time to determine if phototherapy or exchange transfusion is required

47
Q

What is phototherapy and how does it work

A

Phototherapy uses UV light to covert bilirubin to soluble products (eg. lumirubin) that can be excreted without conjugation

48
Q

What are side effects of phototherapy for jaundice

A
  • Eye damage

- Seperation from mother

49
Q

If jaundice due to ABO or Rhesus incompatibility - what is given alongside phototherapy

A

IVIG

50
Q

What is exchange transfusion

A

Donor warmed blood is given to foetus by umbilical vein and removed from umbilical artery. Aim is to remove high bilirubin

51
Q

If biliary atresia is suspected how is jaundice managed

A

Urgent surgical review

52
Q

What worrying syndrome may hyperbillirubinaemia cause

A

Acute bilirubin encephalopathy

53
Q

When does acute bilirubin encephalopathy occur

A

First few days of life

54
Q

How will acute bilirubin encephalopathy present

A
  • Lethargy
  • Hypotonia
  • Irritable
  • Poor Feeding
  • Shrill Cry
55
Q

What is kernicterus

A

Progression from acute bilirubin encephalopathy

56
Q

What are three RF for kernicterus

A
  • Rapidly rising Increase in bilirubin >8.5
  • Serum bilirubin >340
  • Clinical features bilirubin encephalopathy
57
Q

How will kernicterus present

A
  • Vertical Gaze Palsy
  • Cerebral paresis
  • Hearing Impairment
  • Athetosis
  • Intellectual disability
  • Dental enamel hypoplasia
58
Q

Why would jaundice due to biliary atresia not cause kernicterus

A

As only unconjguated hyperbillirubinaemia can cross the BBB to cause kernicterus. Conjugated is water-soluble and therefore cannot cross BBB

59
Q

What is biliary atresia

A

Obliteration or discontinuity of biliary tract

60
Q

In which gender is biliary atresia more common

A

Females

61
Q

How does biliary atresia present clinically

A
  • Prolonged jaundice
  • Dark urine
  • Pale stools
62
Q

What is a sign of biliary atresia

A

Hepatosplenomegaly

63
Q

Explain pathophysiology of biliary atresia

A

Obliteration of biliary tree, leads to cholestasis increases pressure causing portal HTN

64
Q

What investigations are ordered in biliary atresia

A

LFTs
USS
TBIDA scan

65
Q

What may be seen on LFTs in biliary atresia

A

High conjugated bilirubin
Normal total bilirubin
Abnormal liver transaminases

66
Q

What may be seen on USS in biliary atresia

A

Non-patent biliary tree

67
Q

What may be seen on TBIDA scan in biliary atresia

A

Non-patent biliary tree

68
Q

What is management of biliary atresia

A

Hepatoportenterostomy = anastamosis between liver and small intestine

Paediatrics (61 decks)

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