Jaundice Flashcards
When is jaundice considered pathological in children?
Jaundice presenting in the first 24 hours after birth
What typically causes jaundice in the first 24 hours?
Physiological problems in the rbc or cross reaction with the maternal blood:
- TORCH infections
- Rhesus haem disease
- ABO haem disease
- Hereditary spherocytosis
- G6PD deficiency
Why does rhesus disease cause neonatal jaundice?
Especially if 2nd pregnancy - mother may have anti D IgG antibodies that have crossed the placenta and caused fetal haemolysis
What is the difference between Rhesus and ABO disease?
Rhesus: in the 1st pregnancy the fetus is not affected
ABO incompatibility is more common now due to anti D prophylaxis for rhesus
Positive Coombs test for baby indicates which cause of jaundice?
Checks for haemolysis due to immune mediated cause:
Rhesus or ABO haemolytic diseases
Which condition can cause neonatal jaundice and has following: spherocytes on blood film, coombs test negative
Hereditary spherocytosis
Which condition can cause neonatal jaundice and has following: heinz body on blood film, coombs test negativw
G6PD deficiency
Is jaundice seen in babys 2-14 days of birth more common in breast fed or bottle fed babies?
Breastfed and likely physiological
What investigations are done if jaundice is still around after day 14?
Prolonged jaundice screen
What is part of the prolonged jaundice screen?
Conjugated and unconjugated bilirubin
DAT
TFTs
FBC + blood film
What can cause jaundice after 14 days? (prolonged jaundice)
Biliary atresia = raised conjugated bilirubin
Congenital hypothyroidism - screen in guthrie test
Galactosaemia - metabolic disorder
UTI
What is kernicterus?
When unconjugated bilirubin crosses BBB
symptoms:
Lethargy
poor feeding
irritability
hypertonia
seizures
coma
*bilirubin brain damage
How to investigate for jaundiced babies 35< weeks and 24 hours< ?
Transcutaneous bilirubin
if 250+ -> measure serum levels
How to investigate for jaundiced babies less than 24 hours of age
Serum bilirubin within 2 hours
How to investigate for jaundiced babies born for more than 2 weeks?
Split serum bilirubin
When is immediate exchange transfusion done for jaundice management?
Pathological unconjugated -> acute bilirubin encephalopathy
When is phototherapy done for jaundice?
Total bilirubin >95th centile
How does phototherapy work?
It conjugates bilirubin so it can be excreted in urine and faeces so only works for unconjugated bilirubinaemia
How is phototherapy managed over 12 hours?
Bilirubin levels monitered every 4-6 hours at first, then 6-12 hours when levels stable
When can phototherapy be stopped?
Once >50 micromoles/L below treatment threshold,
What is rebound hyperbilirubinaemia?
Levels can go back up after phototherapy so need to check after 12-18 hours
Can breast feeding continue in breast milk jaundice?
Yes, continue
Why can forcep delivery cause jaundice?
Cause of BRUISING
