Jaundice Flashcards
1
Q
What is Jaundice?
A
- Jaundice is the yellow colouring of the skin and sclera caused by the accumulation of bilirubin in the skin and mucous membranes
2
Q
What is Neonatal Jaundice?
A
- Hyperbilirubinaemia that is unconjugated or conjugated
3
Q
What can develop if you have persistently high levels of unconjugated bilirubin?
A
- You can develop Kernicterus
4
Q
What is Kernicterus?
A
- Brain damage due to high levels of unconjugated bilirubin
- Bilirubin can pass the blood-brain barrier
- Excessive bilirubin causes direct damage to the central nervous system
- Kernicterus presents with a less responsive, floppy, drowsy baby with poor feeding
- Damage is permanent causing cerebral palsy, learning disability and deafness
5
Q
What are the two types of Jaundice?
A
- Physiological Jaundice
- Pathological Jaundice
6
Q
What is Physiological Jaundice?
A
- Jaundice in a healthy baby born at term is normal, may be due to:
1. Increased red blood cell breakdown (In utero the foetus has a high concentration of Hb that breaks down releasing bilirubin, normally excreted via the placenta, at birth the foetus no longer has access to the placenta)
2. Immature Liver (not being able to process high bilirubin concentration)- seen in Premature babies
7
Q
When is Physiological Jaundice seen?
A
- Starts at day 2-3 and peaks around day 5, usually resolved by day 10.
8
Q
What is Jaundice within 24hours of life?
A
- Jaundice within the first 24 hours of life = Pathological.
- Babies need to be treated for sepsis
9
Q
What is Breast Milk Jaundice?
A
- Babies that are breastfed are more likely to develop Jaundice
- As there are component of the breast milk which inhibit the liver to breakdown bilirubin
- The babies are more likely to become dehydrated due to not feeding adequately. This leads to slow passage of stools which increase absorption of bilirubin in the intestines.
10
Q
What is the Haemolytic Disease of the Newborn?
A
- Haemolytic Disease of the Newborn causes Haemolysis and Jaundice in the Neonate
- It is caused by incompatibility of the Rhesus Antigens
- If the Mother is Rhesus D Negative and the Baby is Rhesus D Positive, at some point when the blood mixes the mother’s circulation will recognise the Rhesus D Positive on the Hb of the infant as foreign and will produce antibodies to the Hb.
- This is not a problem for the first pregnancy, however, can cause problems for the second pregnancy
- The mother’s anti- D antibodies can cross the placenta into the foetus. If the baby is Rhesus Positive the antibodies can attach themselves to the RBC.
- This can lead to Haemolysis causing anaemia and high bilirubin levels
11
Q
What is Prolonged Jaundice?
A
- Jaundice >14 days in term and >21 days preterm
12
Q
What conditions will you be considering in Prolonged Jaundice?
A
- Infection
- Hypothyroidism
- Biliary Atresia
- G6PD deficiency
13
Q
What are the risk factors for developing jaundice?
A
- Prematurity or low birth weight
- Previous sibling requiring phototherapy
- Exclusively breast fed
- Infant of diabetic mother
- Jaundice < 24 hours
14
Q
What is the Clinical Presentation of babies with Jaundice?
A
- Jaundice of skin and mucous membranes ( sclera, gums and blanche)
- Drowsy: difficult to rouse, not waking for feeds and short feeds
- Neurological: altered muscle tone, seizures
- Other: infection, poor urine output, abdominal mass
15
Q
What investigations would you do for a patient with Jaundice?
A
- Transcutaneous Bilirubinometer (TCB) if >35 weeks and >24 hours
- Serum Bilirubin if <35 weeks and <24 hours
- Conjugated bilirubin (hepatobiliary cause)
- FBC - anaemia
- U+Es = excessive weight loss/ dehydrated
- Direct Coombs Test (Haemolysis)
- TFTs - hypothyroid
- Blood and Urine Cultures: Infection suspected
- G6PD levels looking for deficiency
