Jaundice

Question 1

What is the appearance of urine and stools in conjugated hyperbilirubinaemia?

Answer 1

Urine = dark
Stools = pale

Question 2

What are the important investigations for jaundiced neonates?

Answer 2

1. Conjugated bilirubin measurement
2. LFTS
3. Infection screen - TORCH; surface swabs; throat swabs; urine culture; blood culture; LP; CXR
4. Reducing substance in urine (screening test for galactosaemia)
5. TFTs
6. Haemolysis tests - blood type; Rh; reticulocyte count; Direct Coombs etc.
7. USS (+ other liver imaging investigations)

Question 3

How is jaundice in neonates managed?

Answer 3

Phototherapy

Question 4

What are the complications of phototherapy?

Answer 4

1. Separation from mother
2. Dehydration
3. Loose stools

Question 5

When should phototherapy be stopped?

Answer 5

Once serum bilirubin is = 50micromol/L below the phototherapy threshold (differs between trusts)

Question 6

What should be checked for AFTER phototherapy has been stopped?

Answer 6

Rebound hyperbilirubinaemia - therefore repeat serum bilirubin 12-18 hours after stopping phototherapy

Question 7

When is exchange therapy considered?

Answer 7

When bilirubin rises to levels considered dangerous

Question 8

How much blood should be exchanged in exchange transfusion?

Answer 8

Twice the infants blood volume - 80ml/kg

Question 9

What are the causes of jaundice starting at <24 hours/age?

Answer 9

1. Congenital infection

2. Haemolytic disorders - e.g. Rh incompatibility; ABO incompatibility; G6PD deficiency; spherocytosis

Question 10

What are the causes of jaundice arising between 24 hours and 2 wks of age?

Answer 10

1. Physiological jaundice
2. Breast milk jaundice
3. Infection, esp. UTI
4. Brusing
5. Polycythaemia

Question 11

What are the causes of jaundice that persist beyond 2 weeks?

Answer 11

UNCONJUGATED - hypothyroidism; high GI obstruction; breast milk (still most important cause)
CONJUGATED - bile duct obstruction from either biliary atresia or choledochal cysts; neonatal hepatitis

Question 12

What are the causes of neonatal hepatitis?

Answer 12

Congenital infection
CF
TPN cholestasis
Inborn errors of metabolism - e.g. alpha-1-anti-trypsin/galactosaemia

Question 13

What is kernicterus?

Answer 13

Bilirubin neurotoxicity

Question 14

Which parts of the brain are most commonly affected by kernicterus?

Answer 14

Basal ganglia
Hippocampus
Geniculate bodies
Cranial nerve nuclei

Question 15

What are the complications of untreated kernicterus?

Answer 15

1. CP
2. Learning difficulties
3. Sensioneural deafness