Jaundice

Question 1

What is jaundice defined as

Answer 1

yellowing of the skin, sclera and mucous membranes caused by raised bilirubin levels in the bloodstream.

Question 2

how many % of term and preterm babies have jaundice ?

Answer 2

50-70% of term

80% of preterm

Question 3

Unconjugated vs conjugated difference

Answer 3

unconj = fat soluble 
conj = water soluble

Question 4

describe the steps of physiological path to remove bilirubin from body

Answer 4

1. RBC broken down into haem + globin
2. haem converted into unconj.Bilirubin
3. joins with albumin to be transported to liver
4. in liver unconj + gluceronic acid joined by UDP-G
5. converted into conj Bilirubin which is then waer soluble to be excreted in the urine and feaces

Question 5

is physiological jaundice normal ?

3 reasons why this happens in newborns

Answer 5

yes

1. immature liver
2. excess amounts of RBC that arent needed due to increase in o2 levels
3. no more removal of bilirubin by placenta

Question 6

Why is high levels of bilirubin a problem in newborns

Answer 6

if skin is too saturated, next site to saturate is brain
if bilirubin crosses the blood-brain barrier it is deposited in basal ganglia of brain
named ‘kernicterus’
severe consequences such as cebral palsy, sensual deafness and high mortality

Question 7

When does pathological jaundice arise and why

Answer 7

before 24hrs of birth or after 14 days

arises from factors that alter the usual process of bilirubin metabolism

Question 8

in the 1st 24hrs, what is the cause assumed to be and why

what are some other causes

Answer 8

haemolysis = increased Hb destruction which main cause is Rh incompatibility (mothers blood -ve)

hypoxemia
sepsis
endocrine/metabolic disorder 
hypoglycaemia 
bile duct obstruction

Question 9

name some treatments / management plans of jaundice

Answer 9

feeding plans
SBR
phototherapy 
Checking blood groups of mum and baby
Coobes test
Elution test
Full blood examination
CRP

Exchange transfusion as last step

Question 10

Late neonatal and breastfeeding jaundice?w

what do you need to be checking for when BFing

Answer 10

late - after 14 days

BF - healthy baby, begins at day 5-10… check for flutter sucks to be getting the highest fat content of milk