Jaundice At 24hours To 2 Weeks Of Age Flashcards
Do most babies who are mild-moderately jaundice in this period have no underlying cause?
Yes - the bilirubin has risen as the infant is adapting to transition from fetal life
When can physiological jaundice only be diagnosed?
After other causes have been considered
Is jaundice more common and more prolonged in breastfed infants?
Yes
The hyperbilirubinaemia is unconjugated
Multifactorial cause but may involve increased enterohepatic circulation of bilirubin
In some infants, jaundice is exacerbated if…
Milk intake is poor from a delay in establishing breastfeeding - the infant becomes dehydrated (>10% birth weight loss)
Continue breast feeding, may need supplementation feeding or IV fluids
Why may infection cause an unconjugated hyperbilirubinaemia?
Poor fluid intake
Haemolysis
Reduced hepatic function
Increase in enterohepatic circulation
What infection in particular may cause jaundice?
UTI
Jaundice from haemolysis usually occurs in first day of life, but may it also occur in the first week?
Yes e.g G6PD deficiency, ABO incompatibility
What is Crigler-Najjar syndrome?
When glucuronyl transferase deficient or absent
May result in extremely high levels of unconjugated bilirubin
Is Crigler-Najjer syndrome common or rare?
Very rare!
How can jaundice be observed more easily?
Blanching the skin with a finger
Where does jaundice tend to start?
On the head and face, then spreads down to trunk and limbs
If the baby is clinically jaundice, what test should be done?
Transcutaneous bilirubin meter or blood sample
A high transcutaneous bilirubin must be checked with blood measurement
Should all babies be checked for jaundice clinically with the first 72 hours of life?
Yes
Are preterm infants more susceptible to the damage from raised bilirubin?
Yes - intervention threshold should be lower
What drugs may displace bilirubin from albumin ?
Diazepam
Sulphonamides
- avoided in newborn infants
Infants who have experienced….are more susceptible to damage from severe jaundice
Hypoxia
Hypothermia
Any serious illness
Will poor milk intake and dehydration exacerbate jaundice?
Yes - should be corrected
How is it managed?
Phototherapy is the most widely used therapy, with exchange transfusion for severe cases
How does phototherapy work?
Light from the blue-green band of visible spectrum converts unconjugated bilirubin into a harmless water soluble pigment excreted mainly in urine
How is phototherapy delivered?
Overhead light source placed at optimal distance to achieve high irradiance. Infants eyes covered as bright light uncomfortable
Phototherapy can result in what side effects?
Temperature instability - infant undressed
Macular rash
Bronze discolouration if jaundice is conjugated
When is exchange transfusion required?
If bilirubin rises to levels that are considered potentially dangerous
Describe the exchange transfusion process
Blood removed from baby in small aliquots- usually from arterial line or umbilical vein and replaced with donor blood via peripheral or umbilical vein
How much of the infants volume is usually exchanged?
Twice the infants blood volume (2x90ml/kg)
In exchange transfusion, donors blood should be screened for..
CMV, hep B and C and HIV
Is there a consensus on the bilirubin levels for phototherapy and exchange transfusion?
No
Is phototherapy successful in reducing the need for exchange transfusion?
Yes
Other than physiological jaundice, breastmilk jaundice, dehydration, infection, haemolysis and Crigler-Najjar syndrome, what else can cause/exacerbate jaundice in this time frame?
Bruising e.g cephalhaematoma and polycythemia
In infants with rhesus haemolytic disease or ABO incompatibility that does not respond thenintensive phototherapy, what reduces the need for exchange transfusion?
IV immunoglobulin
What RFs are there for developing significant neonatal jaundice?
Asian, European or Native American ethnicity
Visible jaundice within 24 hours
Gestational age <38 weeks
Male gender
Visible bruising
Maternal factors: DM, > 25 years old, exclusive breastfeeding
Previous siblings needing phototherapy
