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children > Common Neonatal Jaundice > Flashcards

Common Neonatal Jaundice Flashcards

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1
Q

What is neonatal jaundice?

A

accumulation of excess bilirubin in the blood serum

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2
Q

How is bilirubin formed?

A

It is a breakdown product of haemoglobin

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3
Q

What does unconjugated bilirubin do?

A

It is highly lipid soluble and it will cross blood brain barrier

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4
Q

What can be developed from high levels of bilirubin in baby’s blood?

A

Kernicterus ( seizures and brain damage )

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5
Q

What is the result of unconjugated hyperbilirubinemia ?

A
  1. It would increase bilirubin production
  2. It would decrease bilirubin clearance
  3. It would increase enterohepatic circulation
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6
Q

When would it unconjugated hyperbilirubinemia occur.?

A

It would occur within the first 24 hours and the rise of bilirubin level more than 0.2mg/dl per hour or 5mg/dl per day

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7
Q

What are the signs and symptoms of Kernicterus in baby?

A

Lethargic, poor feeding, abnormal tone, and posturing, high pitch cry & irritability

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8
Q

When does physiologic jaundice occur?

A

It occurs between > 24-36 hours
It never occur in the first 24 hours
It usually occur on days 2-4, peaks between 4 to 5 days and resolve in 2 weeks

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9
Q

What is the rate of rise in physiologic jaundice?

A

<85mmol/L

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10
Q

What is the immature hepatic uptake & conjugation process?

A

It requires the liver enzyme glucuronyl transferase to convert unconjugated bilirubin ( indirect bilirubin ) into water-soluble conjugated bilirubin ( direct bilrubin ) - excrete in urine and stool

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11
Q

What is haemolytic jaundice?

A

Hemolytic jaundice occurs as a result of hemolysis, or an accelerated breakdown of red blood cells, leading to an increase in production of bilirubin.

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12
Q

What are the different kinds of haemolytic jaundice?

A
  • G6PD deficiency
  • ABO / Rh incompatibility
  • Drug-induced
  • Cephalohematoma ( Pressure on the fetal head ruptures small blood vessels when the head is compressed against the maternal pelvis during labor or pressure from forceps or a vacuum extractor used to assist the birth
  • Polycythaemia ( is a type of blood cancer. It causes your bone marrow to make too many red blood cells. )
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13
Q

What is physiologic jaundice?

A

A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin. Jaundice due to these normal newborn conditions is called physiologic jaundice

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14
Q

What other jaundices are there?

A
  • Jaundice of prematurity
  • Infection
    Prolonged rupture of membrane
    UTI
    Sepsis
  • Metabolic disorder ( maternal hyperthyroidism , gestational diabetes )
  • Breast milk jaundice ( progesterone from milk decreases activity of liver enzymes in the first few days of breastfeeding )
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15
Q

How do we assess jaundice?

A
  • Cephalocaudal ( Face to Downwards )
  • Should be done in natural light
  • Assess severity of jaundice
  • Risk factor assessment
  • Poor feeding / dehydration
  • Breast feeding, neonatal jaundice and kernicterus
  • ABO & Rh typing and maternal serum screen
  • Transcutaneous bilirubin ( TcB ) measurement
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16
Q

What is TCB measurement

A

The meter measures the yellowness of the subcutaneous tissue of the infant by measuring the difference in optical density of two different wavelengths of light through the skin.

17
Q

TCB measurement is applicable to which age?

A
  • Well neonate, stable vital signs
  • Gestational age > 34 weeks, at least 24 hours of life, up to 14 days of life

If not, they will have to do serum bilirubin

18
Q

When Serum bilirubin level shoud be done ?

A 
When TcB is at or above indicated level below ( umol/L)
0-24 hours : not applicable as neotate must at least be 24 hours
25-36 hours : 140
36-48 hours : 160
49-72 hours : 180
73 - 120 hours : 200
121 hours - 7 days : 220
8 - 14 days : 240
19
Q

Some other tests to be done?

A
  1. FBC, retic count and direct Coomb’s
    Retic count : A reticulocyte count is a blood test that measures how fast red blood cells called reticulocytes are made by the bone marrow and released into the blood.
    Coomb’s : A Coombs test, also known as antiglobulin test is either of two blood tests used in immunohematology.
  2. Urea /Electrolytes /Creatinine : to assist therapy for dehydration
  3. Albumin : SB for albumin ratio
20
Q

Phototherapy

A
  • It involves the exposure of as much as the baby’s skin as possible
  • to blue fluorescent lights, which emits wavelengths in the 430-490nm
  • Decreases the bilirubin level by enhancing the conversion of bilirubin in the exposable skin to a more easily excretable form
  • Bound to albumin, transported to the liver and excreted into bile
  • Increasing the amount of skin exposure to blue lights can enhance bilirubin excretion
21
Q

What to observe during phototherapy?

A
  • Ensure adequate hydration, at least more than 6 wet diapers
  • Observe urine and stool nature & colour
  • Check skin integrity
22
Q

What is the mechanism of excretion of bilirubin?

A

Excessive breakdown of RBC
Fetal HB : 18-20 g/dl
Life span : 90 days

->

Increased unconjugated bilirubin

->
Immature liver produce sufficient enzyme glucuronyl
transferase for bilirubin conjugation

->
Jaundice ( hyperbilirubinemia ) - unconjugated bilirubin

->
Phototherapy

->
Convert to water-soluble bilirubin and excrete via urine and stool

23
Q

Single blue phototherapy

A
  • The exposure of one plane of the body’s surface ( e.g. either the baby’s front or back ) to phototherapy light
  • Regularly turning the baby helps to maximise the exposure of all surfaces ( turning 2-3 hourly )
  • Keep baby warm using heat shield, check 4 hourly temperature, heart rate and respiration rate
  • Use eye covers to prevent damage to baby’s eyes, remove during feeding
24
Q

Double blue phototherapy

A

The simultaneous exposure of two body surface planes to two separate set of blue lights i.e both front and back

  • Recommended if the SB level above double blue phototherapy criteria or if the rate of rise of SB is >5umol/L/hr
25
Q

What are the side effects of phototherapy?

A
  • Increase insensible water loss ; Temperature instability

- Rashes ; Diarrhoea ; Retinal damage

26
Q

If double blue phototherapy doesn’t work out, exchange would be used.

A

Principles of exchange transfusion

An exchange transfusion requires that the person’s blood be removed and replaced.

27
Q

What are the risk factors for phototherapy?

A

Low risk factors : physiological jaundice

High risk factors : pre-term, haemolytic jaundice, sepsis, dehydration

28
Q

What is the management of NNJ?

A

Feeding
- feeding can be continued ; nil by mouth if the baby needs exchange transfusion
- increase feeds by at least 10% over the usual expected intake
- continue breastfeeding
if not near, or at exchange transfusion level, the baby can be taken off the lights for up to 30 mins to breastfeed
- Once the “off phototherapy” level has been reached and the baby has completed at least 24 hours of phototherapy

29
Q

What is parental and caretaker education?

A
  • Follow up advice for babies discharged before age 48 hours
  • Give thorough breastfeeding advice
  • Teach mothers and caregivers the signs of dehydration
30
Q

What are the signs and symptoms of an unwell baby?

A
  1. Medical cause : infection ( URTI, GE, UTI, conjunctivitis, otitis media, meningitis )
  2. Surgical cause : HI, trauma, intussusception, IO, pyloric stenosis, hernia
  3. Significant positive history or physical finding that suggest physical illness ( Poor feeding, decreased feeding, vomiting, fever )
  4. Any features suggestive of NAI or injury
  5. Abnormal FBC, UFEME, AXR
  6. Parental anxiety and inability to cope or poor parent-craft

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