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3: Paeds Y3/4 - Paediatrics [15] > [62] Neonatal Jaundice > Flashcards

[62] Neonatal Jaundice Flashcards

1
Q

What is neonatal jaundice?

A

A yellowish discolouration of the white parts of the eyes and skin in a newborn baby due to excess bilirubin levels

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2
Q

When is jaundice more likely to have a serious underlying cause?

A

Any jaundice presenting in the first 24 hours of life

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3
Q

Give 3 examples of serious underlying causes of jaundice presenting in the first 24 hours?

A
  • Infection
  • Haemolytic disease
  • Metabolic disorders
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4
Q

Why are bilirubin levels higher in neonates than in adults?

A

Because newborn babies have a higher concentration of RBCs, which also have a shorter lifespan

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5
Q

What does RBC breakdown create?

A

Unconjugated bilirubin

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6
Q

How does unconjugated bilirubin circulate?

A

Mostly bound to albumin

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7
Q

What is unconjugated bilirubin metabolised by?

A

The liver

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8
Q

What does the metabolism of unconjugated bilirubin in the liver produce?

A

Conjugated bilirubin

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9
Q

What happens to conjugated bilirubin?

A

It is excreted in the stool

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10
Q

What are the categories of neonatal jaundice?

A
  • Physiological jaundice
  • Early neonatal jaundice
  • Prolonged jaundice
  • Conjugated hyperbilirubinaemia
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11
Q

What is considered to be early neonatal jaundice?

A

Onset less than 24 hours

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12
Q

What is prolonged neonatal jaundice?

A

Jaundice lasting for more than 14 days in term infants, and 21 days in pre-term

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13
Q

What does physiological jaundice result from?

A

Increased erythrocyte breakdown and immature liver function

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14
Q

What can cause early neonatal jaundice?

A
  • Haemolytic disease
  • Infection
  • Increased haemolysis due to haematoma
  • Maternal autoimmune haemolytic anaemia
  • Crigler-Najjar syndrome or Dublin-Johnson syndrome
  • Gilbert’s syndrome
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15
Q

Give an example of a cause of haemolytic disease leading to early neonatal jaundice?

A

Haemolytic disease of the newborn

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16
Q

Give 3 examples of causes of infection that can lead to early neonatal jaundice

A
  • Congenital infections
  • Herpes simplex
  • Postnatal infection
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17
Q

Give an example of a maternal autoimmune haemolytic anaemia that can lead to early neonatal jaundice

A

SLE

18
Q

What are the causes of prolonged neonatal jaundice?

A
  • Infection
  • Hypothyroidism or hypopituitarism
  • Galactosaemia
  • Breast milk jaundice
  • GI causes
19
Q

Give an example of an infection that can cause prolonged neonatal jaundice

A

UTI

20
Q

Give 3 GI causes of prolonged neonatal jaundice

A
  • Biliary atresia
  • Choledochal cyst
  • Neonatal hepatitis
21
Q

What are the causes of conjugated hyperbilirubinaemia in neonates?

A
  • Infection
  • Parenteral nutrition
  • Cystic fibrosis
  • Metabolic disorders
  • GI causes
  • Endocrine causes
22
Q

Give 2 metabolic disorders that can cause conjugated hyperbilirubinaemia in neonates

A
  • Alpha-1-antitrypsin deficiency

- Galactosaemia

23
Q

Give 3 GI causes of conjugated hyperbilirubinaemia in neonates?

A
  • Biliary atresia
  • Choledochal cyst
  • Hepatitis
24
Q

Give 2 examples of endocrine causes of conjugated hyperbilirubinaemia in neonates

A
  • Hypothyroidism

- Hypopituitarism

25
Q

What are the risk factors for neonatal jaundice?

A
  • Low birth weight
  • Breast-fed babies
  • Previous sibling with neonatal jaundice requiring phototherapy
  • Visible jaundice in first 24 hours
  • Infants of mothers with diabetes
  • Male gender
  • East Asians
26
Q

Where does neonatal jaundice first become visible?

A

In the face and forehead

27
Q

How is the underlying colour revealed in neonatal jaundice?

A

Blanching

28
Q

How does the distribution of neonatal jaundice progress?

A

It gradually becomes visible on the trunk and extremities

29
Q

What is true of physical examination in most infants with neonatal jaundice?

A

Yellow colour is the only finding on physical examination

30
Q

What may more severe cases of neonatal jaundice be associated with?

A

Drowsiness

31
Q

Why should other signs be looked out for when assessing neonatal jaundice?

A

As they may be associated with an underlying cause

32
Q

What is usually the only testing required in neonatal jaundice?

A

A total serum bilirubin

33
Q

When is further investigation essential in neonatal jaundice?

A

For any baby who is unwell, presents in the first 24 hours, or has prolonged (10 days) jaundice

34
Q

What further investigations may be done in jaundice?

A
  • LFTs
  • Infection screen
  • Haemolysis tests
  • TFTs
35
Q

What haemolysis tests may be done in neonatal jaundice?

A
  • Blood type and Rh determination of mother and infant
  • Reticulocyte count
  • Direct Coomb’s test
36
Q

What is involved in the basic management of neonatal jaundice? -

A
  • Monitoring of bilirubin levels
  • Treatment of underlying cause
  • Increase in fluid intake
37
Q

How is an increase in fluid intake achieved in neonatal jaundice?

A

Usually oral, but may require IV fluids depending on cause and well-being of baby

38
Q

What are the further management options for neonatal jaundice?

A
  • Phototherapy
  • Exchange transfusion
  • IV immunoglobulin
39
Q

What are the indications for phototherapy dependant on in neonatal jaundice?

A
  • Serum bilirubin
  • Gestation of the baby
  • Rate of rise of bilirubin
  • Likely underlying cause
  • Well-being of the baby
40
Q

When should you refer an infant with neonatal jaundice for urgent hospital assessment?

A
  • If jaundice presents in first 24 hours of life
  • If baby is jaundiced and unwell
  • Prolonged jaundice
41
Q

What is an important complication of neonatal jaundice?

A

Kernicterus

3: Paeds Y3/4 - Paediatrics [15] (115 decks)

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