jaundice

Question 1

is jaundice common?

Answer 1

yes 60% of term and 80% of prem have jaundice in 1st week of life

Question 2

what are the causes of early jaundice

Answer 2

within first 24hrs of life
ALWAYS PATHOLOGICAL
- haemoltytic 
-> ABO/Rh incompatibility
-> G6PD deficiency 
- congenital infection TORCH - neonatal hepatitis

Question 3

what are the causes of intermediate jaundice

Answer 3

2-10days of life - unconjugated
physiological 
breast milk jaundice 
sepsis
haemolytic 
polycythaemia

Question 4

what are the causes of late jaundice

Answer 4

>day 10
conjugated 
- bile duct obstruction seen in CF
- biliary atresia 
- neonatal hepatitis 
unconjugated 
-physiological 
-breast milk jaundice 
-sepsis
-haemolytic 
-polycythaemia

Question 5

ix and mx for neonatal jaundice

Answer 5

ix

• bili levels
• LFT
• FBC + film
• blood group
• mother blood group
• direct coombs test
• G6PD levels

mx
medical emergency 
call for help from senior 
start phototherapy asap 
NICU/PICU/paed review

Question 6

what is phsyiological jaundice

Answer 6

common, normal

• increased bili production
• increased HB concentration, decreased RBC life span
• decreased ability of liver to conjugate and excrete bili

Question 7

what are factors that exacerbate phsyiological jaundice

Answer 7

• premi
• bruising
• cephalohematoma
• sepsis
• delayed mec
• breast feeding

Question 8

ix and mx of physiological and breast milk jaundice

Answer 8

ix

• bili (unconjugated picture)
• LFT
• dx of exclusion

mx
do not stop breast feeding
can remain for 2wks in term and 3 weeks in prem
dc home
- not for sunlight exposure
- fu with gp
- recheck bili in 24-48hrs if borederline or raised
- represent if pale stools, dark urine, unwell, poor feeding, prolonged jaundice

Question 9

why does breast milk jaundice occur

Answer 9

substances in breast milk inhibit conjugation of bili

Question 10

what is kernicterus

• phases
• mx
• cx

Answer 10

bilirubin encepahlopathy 
unconjugatedbili crosses BBB and is neurotoxic 
phase 1 
- hypotonic, decreased feeding, lethargy
phase 2 
- hyerptonic 
phase 3 
- high pitch cry, visual/hearing loss

mx
phototherapy (bili blanket, light)
exchange transfusion
IvIg

cx
intellectual impairment 
CP 
sensironeural hearing loss
upward gaze palsy

Question 11

what is biliary atresia and why is prompt dx important

Answer 11

congenital absence of intra or extra hepatic ducts
conjugated bili rise
pale stools, dark urine
hepatomegaly
malnutrition
but otehrwise well baby
need to detect by 6 weeks for surgical candidate