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TAS Neonatal Medicine ✅ > Assessment of Jaundice ✅ > Flashcards

Assessment of Jaundice ✅ Flashcards

1
Q

Where does jaundice first appear?

A

Sclera and face

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2
Q

How does the distribution of jaundice progress?

A

Cephalocaudally, appearing last on feet and soles

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3
Q

What may be helpful in clinically detecting jaundice?

A

Examination of balanced skin in natural light

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4
Q

Who is it more difficult to clinically detect jaundice in?

A
  • Preterm babies

- Dark skinned infants

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5
Q

Can a baby who does not have clinical jaundice have significant hyperbilirubinaemia?

A

It is unlikely

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6
Q

Can the severity of jaundice be assessed by the clinical appearance of a baby once they have become jaundiced?

A

No

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7
Q

How should bilirubin initially be measured in term babies who appear jaundiced?

A

Transcutaneous bilirubin

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8
Q

At what gestation age can a transcutaneous bilirubinometer be used?

A

35 weeks+

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9
Q

How long after birth can a transcutaneous bilirubinometer be used?

A

After 24 hours

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10
Q

How does a transcutaneous bilirubinometer work?

A

It uses multi wave reflectance

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11
Q

How accurate is a transcutaneous bilirubinometer?

A

Good - correlation coefficient of 0.9 - up to bilirubin levels of 250µmol/L

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12
Q

What are transcutaneous bilirubinometers useful for?

A

Screening tools

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13
Q

In what settings can transcutaneous bilirubinometers be used?

A
  • Community

- Postnatal wards

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14
Q

When should a serum bilirubin measurement be obtained?

A
  • If the infant is jaundiced and <24 hours old
  • Transcutaneous bilirubinometer measure >250µmol/L
  • Transcutaneous bilirubinometer not available
  • Infant jaundiced and ≤35 weeks gestational age
  • Infant is on or has had phototherapy
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15
Q

Why can a transcutaneous bilirubinometer not be used if an infant is on or has had phototherapy?

A

It lowers the cutaneous bilirubin levels more readily than serum bilirubin

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16
Q

What increases the risk of developing significant hyperbilirubinaemia in neonates?

A
  • Birth gestation <38 weeks
  • History of jaundice requiring phototherapy in a sibling
  • Visible jaundice developing in the first 24 hours after birth
  • Exclusive breast-feeding
17
Q

What should be done if infants have risk factors for significant hyperbilirubinaemia?

A

They should have a clinical examination for jaundice before 48 hours of age

18
Q

What should be done if an infant with risk factors has signs of jaundice on clinical examination?

A

Bilirubin levels should rechecked with a transcutaneous bilirubinometer measurement

19
Q

What is a serum bilirubin of >102mmol/L in the first 24 hours of life predictive of?

A

A bilirubin >290mmol/L on days 3-5

20
Q

What has a good accuracy in predicting subsequent hyperbilirubinaemia in neonates pre-discharge?

A

Transcutaneous bilirubin plotted on hour specific nomograms

21
Q

What investigations are not able to predict significant hyperbilirubinaemia?

A
  • Umbilical cord bilirubin
  • Direct antiglobulin testing
  • End-tidal CO measurement
22
Q

How might end tidal CO measurement be useful in predicting future significant hyperbilirubinaemia?

A

Shows good negative predictive value

23
Q

When are investigations to determine the cause of jaundice required?

A
  • If it appears within the first 24 hours
  • Rapid rate of rise
  • High serum bilirubin after 24 hours
  • Persistent jaundice
  • High conjugated fraction
24
Q

What rate of rise of bilirubin would require investigations to determine a cause?

A

More than 85µmol/L/day or 8.5µmol/L/hour

25
Q

What serum bilirubin at 72 hours would need investigation to determine the cause of jaundice in term infants?

A

More than 200µmol/L

26
Q

What is considered persistent jaundice requiring investigation to determine underlying cause?

A

14 days at term, 21 days in preterm

27
Q

What conjugated fraction of bilirubin indicates a need to investigate underlying causes?

A

More than 35µmol/L

28
Q

What should the initial investigations in jaundice include?

A
  • Serum bilirubin
  • Haematocrit
  • Blood group and Rh type of mother and baby
  • Direct agglutination (Coombs) test
29
Q

What should the result of the Coombs test be interpreted taking into account?

A
  • The strength of the reaction

- If the mother had prophylactic anti-D during pregnancy

30
Q

What investigations into underlying pathology might be done in jaundice?

A
  • FBC
  • Peripheral blood film
  • Sepsis work up to include culture of blood, urine, and CSF
  • G6PD levels

TAS Neonatal Medicine ✅ (35 decks)

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