Jaundice At 24hours To 2 Weeks Of Age

Question 1

Do most babies who are mild-moderately jaundice in this period have no underlying cause?

Answer 1

Yes - the bilirubin has risen as the infant is adapting to transition from fetal life

Question 2

When can physiological jaundice only be diagnosed?

Answer 2

After other causes have been considered

Question 3

Is jaundice more common and more prolonged in breastfed infants?

Answer 3

Yes
The hyperbilirubinaemia is unconjugated
Multifactorial cause but may involve increased enterohepatic circulation of bilirubin

Question 4

In some infants, jaundice is exacerbated if…

Answer 4

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

Question 5

Why may infection cause an unconjugated hyperbilirubinaemia?

Answer 5

Poor fluid intake
Haemolysis
Reduced hepatic function
Increase in enterohepatic circulation

Question 6

What infection in particular may cause jaundice?

Answer 6

UTI

Question 7

Jaundice from haemolysis usually occurs in first day of life, but may it also occur in the first week?

Answer 7

Yes e.g G6PD deficiency, ABO incompatibility

Question 8

What is Crigler-Najjar syndrome?

Answer 8

When glucuronyl transferase deficient or absent

May result in extremely high levels of unconjugated bilirubin

Question 9

Is Crigler-Najjer syndrome common or rare?

Answer 9

Very rare!

Question 10

How can jaundice be observed more easily?

Answer 10

Blanching the skin with a finger

Question 11

Where does jaundice tend to start?

Answer 11

On the head and face, then spreads down to trunk and limbs

Question 12

If the baby is clinically jaundice, what test should be done?

Answer 12

Transcutaneous bilirubin meter or blood sample

A high transcutaneous bilirubin must be checked with blood measurement

Question 13

Should all babies be checked for jaundice clinically with the first 72 hours of life?

Answer 13

Yes

Question 14

Are preterm infants more susceptible to the damage from raised bilirubin?

Answer 14

Yes - intervention threshold should be lower

Question 15

What drugs may displace bilirubin from albumin ?

Answer 15

Diazepam
Sulphonamides
- avoided in newborn infants

Question 16

Infants who have experienced….are more susceptible to damage from severe jaundice

Answer 16

Hypoxia
Hypothermia
Any serious illness

Question 17

Will poor milk intake and dehydration exacerbate jaundice?

Answer 17

Yes - should be corrected

Question 18

How is it managed?

Answer 18

Phototherapy is the most widely used therapy, with exchange transfusion for severe cases

Question 19

How does phototherapy work?

Answer 19

Light from the blue-green band of visible spectrum converts unconjugated bilirubin into a harmless water soluble pigment excreted mainly in urine

Question 20

How is phototherapy delivered?

Answer 20

Overhead light source placed at optimal distance to achieve high irradiance. Infants eyes covered as bright light uncomfortable

Question 21

Phototherapy can result in what side effects?

Answer 21

Temperature instability - infant undressed
Macular rash
Bronze discolouration if jaundice is conjugated

Question 22

When is exchange transfusion required?

Answer 22

If bilirubin rises to levels that are considered potentially dangerous

Question 23

Describe the exchange transfusion process

Answer 23

Blood removed from baby in small aliquots- usually from arterial line or umbilical vein and replaced with donor blood via peripheral or umbilical vein

Question 24

How much of the infants volume is usually exchanged?

Answer 24

Twice the infants blood volume (2x90ml/kg)

Question 25

In exchange transfusion, donors blood should be screened for..

Answer 25

CMV, hep B and C and HIV

Question 26

Is there a consensus on the bilirubin levels for phototherapy and exchange transfusion?

Answer 26

No

Question 27

Is phototherapy successful in reducing the need for exchange transfusion?

Answer 27

Yes

Question 28

Other than physiological jaundice, breastmilk jaundice, dehydration, infection, haemolysis and Crigler-Najjar syndrome, what else can cause/exacerbate jaundice in this time frame?

Answer 28

Bruising e.g cephalhaematoma and polycythemia

Question 29

In infants with rhesus haemolytic disease or ABO incompatibility that does not respond thenintensive phototherapy, what reduces the need for exchange transfusion?

Answer 29

IV immunoglobulin

Question 30

What RFs are there for developing significant neonatal jaundice?

Answer 30

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