23. Neonatal jaundice

Question 1

Reasons for jaundice:

Answer 1

• Increased RBC breakdown
• Faulty enzymes or cells
• Inadequate drainage

Question 2

Risk factors for neonatal jaundice:

Answer 2

• Low birth weight
• Breast fed babies
• Previous sibling requiring phototherapy
• Visible jaundice in 1st 24h
• Male infants or east Asians
• Diabetic mother
• Populations at high altitude

Question 3

Acute encephalopathy symptoms:

Answer 3

• Lethargy
• Decreased feeding
• Tone abnormalities
• High pitched cry
• Torticollis / Wry neck – twisting of the neck
• Dramatic posture
• Seizures

Question 4

Chronic encephalopathy:

Answer 4

Not reversible!

• Movement disorders (Cerebral palsy)
• Auditory dysfunction
• Oculomotor impairment
• Dental dysplasia

Question 5

Neonatal jaundice (early)

Answer 5

<24h post birth, caused by haemolytic disease of the newborn.
Consider starting antibiotics.

Question 6

Haemolytic disease of a newborn:

Answer 6

Rhesus disease decreasing due to Anti-D therapy
ABO incompatibility can occur (anti-A)
Causes hyperbilirubinemia, anaemia, hepatosplenomegaly
Bebos – Direct Antiglobulin Test +ve

Question 7

Causes of haemolytic disease of a newborn:

Answer 7

• Congenital (TORCH)
• Sepsis
• G6DP
• Hereditary spherocytosis

Question 8

DAT positive jaundice:

Answer 8

• Give folic acid supplements for 6-8 weeks

- Follow up FBC for haemolytic anaemia

Question 9

Neonatal jaundice:

Answer 9

> 24h post birth

• breast milk jaundice
• physiological jaundice

Question 10

Causes for >24h neonatal jaundice:

Answer 10

• Hypothyroidism
• Hypopituitarism
• Metabolic disorders
• Cystic fibrosis
• Neonatal hepatitis
• Gilbert’s syndrome
• Biliary atresia

Question 11

Prolonged jaundice:

Answer 11

At 14 days of life of term baby

At 21 days of life in preterm baby

Question 12

Investigations in prolonged jaundice:

Answer 12

Check for conjugated hyperbilirubinemia, positive if:

Direct globulin >25umol/L or if >25% of total bilirubin

Question 13

Significant illnesses in prolonged jaundice:

Answer 13

• Pale stools/ dark urine
• Hepatosplenomegaly/ abdominal masses
• Coagulopathy / abnormal transaminases
• Encephalopathy
• Dysmorphism or congenital heart disease

Question 14

Transcutaneous bilirubinometer use:

Answer 14

> 35 weeks gestation AND >24 hours old

Question 15

Serum bilirubin:

Answer 15

Needed when transcutaneous bilirubinometer can’t be used or TCB >250 qmol/L

Question 16

First line investigations for jaundice:

Answer 16

Total bilirubin, FBC, blood group, DAT (Direct antiglobulin test)

Question 17

Hyperbilirubinemia treatment:

Answer 17

• Phototherapy
• Exchange transfusion
• IV immunoglobulin

Question 18

Phototherapy:

Answer 18

• Main treatment
• Ensure good hydration
• Repeat bilirubin every 4-6h
• Multiple phototherapy can be converted to single if bilirubin is >50umol/L BELOW exchange transfusion line
• Single phototherapy can be stopped if >50 umol/L below phototherapy threshold
• Check rebound bilirubin at 12-18h after stopping phototherapy

Question 19

Exchange transfusion:

Answer 19

• Used for severe hyperbilirubinemia

- Not without risk, close monitoring required

Question 20

IVIG:

Answer 20

-Used in severe hyperbilirubinemia and haemolysis