Jaundice Flashcards
What is bilirubin?
A product of the haemolysis of RBC
What are the 3 products of haemolysis?
- Unconjugated bilirubin
- Globin
- Iron
What happens to most of the unconjugated bilirubin?
Binds to albumin, but some is free and able to enter the brain
(fat soluble so goes to areas of fat and stains them, e.g. skin, eyes, gums, roof of mouth)
What role does the liver have?
Metabolises unconjugated bilirubin to conjugated bilirubin, which then passes to the gut and is converted to urobilinogen and excreted
What is serum bilirubin?
The amount of bilirubin in the blood
What is another name for Jaundice?
Hyperbilirubinaemia
What is Jaundice?
Raised levels of bilirubin in the body due to babies having raised RBC levels after birth
Which babies are more likely to experience physiological Jaundice?
Breastfed babies
Which types of Jaundice require investigation +/- treatment?
- Pathological jaundice
- SBR rises between days 3 and 4
- Continues after 12-14 days
- Abnormally high SBR
- Baby unwell
What is pathological jaundice?
Jaundice before 24 hours old (neonatal emergency)
What causes pathological jaundice?
- Increased haemolysis
- Prematurity
- Decreased albumin binding capacity
- Competition for albumin binding sites
- Lack of oxygen/glucose
- Hepatitis/liver damage
- Biliary atresia
- Slow bowel motility
What may cause increased haemolysis?
- Rh isoimmunisation/ ABO incompatibility
- Sepsis
- Bruising/internal haemorrhage
What may cause decreased albumin binding capacity?
- Hypoxia
- Infection
- Prematurity
- Hypogylcaemia
What is biliary atresia?
Abnormal formation of part of the liver that drains into the bile duct (treated with surgery if caught early, otherwise may need liver transplant)
What is a meconium plug?
- Takes longer to come out
- Hard (like a proper stool)
- Mixed with mucous
- INFORM PAED
What is prolonged jaundice?
Jaundice lasting >14 days (term) or >21 days (preterm)
What needs to be done for babies with prolonged jaundice?
Split bilirubin test
What are the risks associated with jaundice?
- Penetrates the blood-brain barrier
- Toxic to neural tissue
- Can cause bilirubin encephalopathy (neurological dysfunction)
What is Kernicterus?
The clinical features of bilirubin encephalopathy and the associated yellow staining of the brain
What are the symptoms of Kernicterus?
- Lethargy
- Rigidity
- High pitched cry
- Convulsions
- If gets to the point of convulsions, 50% of these babies die
What is used to measure bilirubin levels?
Transcutaneous bilirubinometer (OR serum bilirubin)
When should serum bilirubin rather than bilirubin be measured?
- In the first 24 hours of life
- Born <35/40
- At/above treatment threshold
Why is feeding so important?
- Speeds up passage of meconium
- Energy required for liver functioning
- ## Fluid needed for babies under hot phototherapy
What observations are required for babies under phototherapy?
4 hourly temperatures
What will be used if the baby cannot maintain a normal temperature?
Biliblanket
