Jaundice

Question 1

What is bilirubin?

Answer 1

A product of the haemolysis of RBC

Question 2

What are the 3 products of haemolysis?

Answer 2

1. Unconjugated bilirubin
2. Globin
3. Iron

Question 3

What happens to most of the unconjugated bilirubin?

Answer 3

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)

Question 4

What role does the liver have?

Answer 4

Metabolises unconjugated bilirubin to conjugated bilirubin, which then passes to the gut and is converted to urobilinogen and excreted

Question 5

What is serum bilirubin?

Answer 5

The amount of bilirubin in the blood

Question 6

What is another name for Jaundice?

Answer 6

Hyperbilirubinaemia

Question 7

What is Jaundice?

Answer 7

Raised levels of bilirubin in the body due to babies having raised RBC levels after birth

Question 8

Which babies are more likely to experience physiological Jaundice?

Answer 8

Breastfed babies

Question 9

Which types of Jaundice require investigation +/- treatment?

Answer 9

• Pathological jaundice
• SBR rises between days 3 and 4
• Continues after 12-14 days
• Abnormally high SBR
• Baby unwell

Question 10

What is pathological jaundice?

Answer 10

Jaundice before 24 hours old (neonatal emergency)

Question 11

What causes pathological jaundice?

Answer 11

• Increased haemolysis
• Prematurity
• Decreased albumin binding capacity
• Competition for albumin binding sites
• Lack of oxygen/glucose
• Hepatitis/liver damage
• Biliary atresia
• Slow bowel motility

Question 12

What may cause increased haemolysis?

Answer 12

• Rh isoimmunisation/ ABO incompatibility
• Sepsis
• Bruising/internal haemorrhage

Question 13

What may cause decreased albumin binding capacity?

Answer 13

• Hypoxia
• Infection
• Prematurity
• Hypogylcaemia

Question 14

What is biliary atresia?

Answer 14

Abnormal formation of part of the liver that drains into the bile duct (treated with surgery if caught early, otherwise may need liver transplant)

Question 15

What is a meconium plug?

Answer 15

• Takes longer to come out
• Hard (like a proper stool)
• Mixed with mucous
• INFORM PAED

Question 16

What is prolonged jaundice?

Answer 16

Jaundice lasting >14 days (term) or >21 days (preterm)

Question 17

What needs to be done for babies with prolonged jaundice?

Answer 17

Split bilirubin test

Question 18

What are the risks associated with jaundice?

Answer 18

• Penetrates the blood-brain barrier
• Toxic to neural tissue
• Can cause bilirubin encephalopathy (neurological dysfunction)

Question 19

What is Kernicterus?

Answer 19

The clinical features of bilirubin encephalopathy and the associated yellow staining of the brain

Question 20

What are the symptoms of Kernicterus?

Answer 20

• Lethargy
• Rigidity
• High pitched cry
• Convulsions
• If gets to the point of convulsions, 50% of these babies die

Question 21

What is used to measure bilirubin levels?

Answer 21

Transcutaneous bilirubinometer (OR serum bilirubin)

Question 22

When should serum bilirubin rather than bilirubin be measured?

Answer 22

• In the first 24 hours of life
• Born <35/40
• At/above treatment threshold

Question 23

Why is feeding so important?

Answer 23

• Speeds up passage of meconium
• Energy required for liver functioning
• ## Fluid needed for babies under hot phototherapy

Question 24

What observations are required for babies under phototherapy?

Answer 24

4 hourly temperatures

Question 25

What will be used if the baby cannot maintain a normal temperature?

Answer 25

Biliblanket