Assessment of Jaundice ✅ Flashcards
Where does jaundice first appear?
Sclera and face
How does the distribution of jaundice progress?
Cephalocaudally, appearing last on feet and soles
What may be helpful in clinically detecting jaundice?
Examination of balanced skin in natural light
Who is it more difficult to clinically detect jaundice in?
- Preterm babies
- Dark skinned infants
Can a baby who does not have clinical jaundice have significant hyperbilirubinaemia?
It is unlikely
Can the severity of jaundice be assessed by the clinical appearance of a baby once they have become jaundiced?
No
How should bilirubin initially be measured in term babies who appear jaundiced?
Transcutaneous bilirubin
At what gestation age can a transcutaneous bilirubinometer be used?
35 weeks+
How long after birth can a transcutaneous bilirubinometer be used?
After 24 hours
How does a transcutaneous bilirubinometer work?
It uses multi wave reflectance
How accurate is a transcutaneous bilirubinometer?
Good - correlation coefficient of 0.9 - up to bilirubin levels of 250µmol/L
What are transcutaneous bilirubinometers useful for?
Screening tools
In what settings can transcutaneous bilirubinometers be used?
- Community
- Postnatal wards
When should a serum bilirubin measurement be obtained?
- 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
Why can a transcutaneous bilirubinometer not be used if an infant is on or has had phototherapy?
It lowers the cutaneous bilirubin levels more readily than serum bilirubin
What increases the risk of developing significant hyperbilirubinaemia in neonates?
- 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
What should be done if infants have risk factors for significant hyperbilirubinaemia?
They should have a clinical examination for jaundice before 48 hours of age
What should be done if an infant with risk factors has signs of jaundice on clinical examination?
Bilirubin levels should rechecked with a transcutaneous bilirubinometer measurement
What is a serum bilirubin of >102mmol/L in the first 24 hours of life predictive of?
A bilirubin >290mmol/L on days 3-5
What has a good accuracy in predicting subsequent hyperbilirubinaemia in neonates pre-discharge?
Transcutaneous bilirubin plotted on hour specific nomograms
What investigations are not able to predict significant hyperbilirubinaemia?
- Umbilical cord bilirubin
- Direct antiglobulin testing
- End-tidal CO measurement
How might end tidal CO measurement be useful in predicting future significant hyperbilirubinaemia?
Shows good negative predictive value
When are investigations to determine the cause of jaundice required?
- If it appears within the first 24 hours
- Rapid rate of rise
- High serum bilirubin after 24 hours
- Persistent jaundice
- High conjugated fraction
What rate of rise of bilirubin would require investigations to determine a cause?
More than 85µmol/L/day or 8.5µmol/L/hour
What serum bilirubin at 72 hours would need investigation to determine the cause of jaundice in term infants?
More than 200µmol/L
What is considered persistent jaundice requiring investigation to determine underlying cause?
14 days at term, 21 days in preterm
What conjugated fraction of bilirubin indicates a need to investigate underlying causes?
More than 35µmol/L
What should the initial investigations in jaundice include?
- Serum bilirubin
- Haematocrit
- Blood group and Rh type of mother and baby
- Direct agglutination (Coombs) test
What should the result of the Coombs test be interpreted taking into account?
- The strength of the reaction
- If the mother had prophylactic anti-D during pregnancy
What investigations into underlying pathology might be done in jaundice?
- FBC
- Peripheral blood film
- Sepsis work up to include culture of blood, urine, and CSF
- G6PD levels
