6.2.2. Neonatology - Common Post-Natal Problems - Jaundice

Question 1

What are the Different Causes of Neonatal Jaundice?

Answer 1

1. Physiological
2. Breast Milk Jaundice
3. Pathological

Question 2

What are the Neonatal Pathological Causes of Jaundice?

Answer 2

1. Early Jaundice - < 24 hours
2. Haemolysis - Rhesus Incompatibility / Other Antibodies / ABO Incompatibility
3. Infection
4. Hereditary Anaemias

Question 3

What are the Investigations of Neonatal Jaundice?

Answer 3

1. Bilirubinometer
2. Serum Bilirubin (Including Conjugated Fraction)
3. Full Blood Count
4. Blood Film
5. Blood Group and Coomb’s Test

Question 4

What are the Treatments of Neonatal Jaundice?

Answer 4

1. Treat the Underlying Cause
2. Hydrate
3. Phototherapy
4. Exchange Transfusion
5. Immunoglobulin

Question 5

What are the Features of Conjugated Jaundice?

Answer 5

1. Rare Cause of Neonatal Jaundice
2. Worry if Conjugated Fraction > 10-15%
3. Need to Exclude Biliary Atresia
4. HIDA Scan Investigation
5. Surgery more likely to Succeed if done < 6 weeks old
6. High chance that Liver Transplant will be Required

Question 6

What is Kernicterus?

Answer 6

Acute / Chronic Bilirubin Encephalopathy

Question 7

What are the 3 Phases of Acute Kernicterus?

Answer 7

Phase 1 - First Few Days of Life - Decreased Alertness / Hypotonia / Poor Feeding
Phase 2 - Variable Onset and Duration / Hypertonia of Extensor Muscles / Retrocollis / Opisthotonus
Phase 3 - Infants > 1 week of age - Hypotonia

Question 8

What are the Features of Chronic Kernicterus?

Answer 8

1. 1st Year - Hypotonia / Hyperreflexia / Delayed Acquisition of Motor Milestones
2. Extrapyramidal - Athetosis / Chorea / Upper Limbs > Lower Limbs
3. Visual - Occular Movements - Upard Gase
4. Auditory - High Frequency Hearing Loss / Delayed Language
5. Cognitive - Not Severely Affected