Jaundice Flashcards
What is jaundice?
Yellow colouring of skin and sclera caused by an accumulation of bilirubin in the skin/mucous membranes
What percentage of term infants does neonatal jaundice occur in?
60%
What percentage of pre-term infants does neonatal jaundice occur in?
80%
List the different types of hyperbilirubinemia
Unconjugated (can be physiological or pathological)
Conjugated
What can untreated hyperbilirubinemia cause?
Kernicterus
Describe causes of physiological jaundice
Increased red blood cell breakdown
Immature liver
How long does physiological jaundice occur?
starts at day 2-3, peaks at day 5 and resolves by day 10
What can physiological jaundice lead to?
Pathological jaundice
When might physiological jaundice progress to pathological?
Premature
Increased red cell breakdown
List some causes of pathological jaundice
Haemolytic disease - Haemolytic disease of the newborns, ABO, G6PD deficiency, spherocytosis
Unwell neonate - congenital or post-natal infection
Prolonged jaundice - infection, hypothyroid, pituitarism, galactosaemic, breast milk jaundice, biliary atresia
Bilirubin above phototherapy threshold - dehydration or haemolysis
List some risk factors for pathological hyperbilirubinemia
Prematurity, low birth weight, small for dates
Previous sibling required phototherapy
Exclusively breast fed
Jaundice <24hrs
Infant of diabetic mother
Describe the clinical presentation of jaundice
Colour - skin, sclera and mucous membranes
Drowsy
Neurologically - altered muscle tone or seizures
Other - sign of infection, poor urine output, abdominal mass/Organomegaly, stool remains black
What investigations are done for jaundice?
Transcutaneous bilirubinometer
Serum bilirubin
Total and conjugated bilirubin
Blood group and DCT
FBC for haemoglobin and haematocrit
U&Es
Infection screen
Glucose6phosphate dehydrogenase
LFTs
TFTs
Describe the management of jaundice
Interpret bilirubin level treatment threshold graph - gestation specific
Phototherapy
IV fluids if needed only
NGT
Exchange transfusion
IVIG
