jaundice in the newborn

Question 1

jaundice in the first 24hrs is always pathological or physiological ?

Answer 1

pathological

Question 2

causes of jaundice in the first 24hrs

Answer 2

rhesis haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
G6PD

Question 3

jaundice in neonate from 2-14days

Answer 3

common + usualyl physiological
- more RBCs, more fragile RBCs, less developed liver

more commonly seen in breastfed babies

Question 4

criteria for prolonged jaundice in the neonate

Answer 4

after 14days - 21 days if premature

Question 5

causes of prolonged jaundice

Answer 5

biliary atresia
hypothyroidism
galactosaemia
UTI
breast milk jaundice
prematurity - immature liver
congenital infections - CMV, toxoplasmosis

Question 6

haemorrhagic disease of the newborn (HDN)

Answer 6

newborns are deficient in vit K -> may result in impaired production of clotting factors which in turn can lead to haemorrhagic disease of the newborn

bleeding can range from bruising to intracranial haemorrhages

–> all newborns offered vit K IM or orally

Question 7

risk factors for haemorrhagic disease of newborn

Answer 7

breast fed - poor source of vit K

maternal use of antiepileptics

Question 8

haemolytic disease of newborn

Answer 8

immune condition which develops after a rhesus negative mother becomes sensitised to the rhesus positive blood cells of her baby whilt in utero

Question 9

features of haemolytic anaemia

Answer 9

hydrops fetalis appearing as fetal oedema in at least 2 compartments seen on US - pericardial effusion, ascites

yellow coloured amniotic fluid due to excess bilirubin
jaundice + kernicterus in the neonate
skin pallor
hepatosplenomegaly

Question 10

haemolytic uraemic syndrome

Answer 10

generally seen in young children + produces a triad of -
- acute kidney injury
- microangiopathic haemolytic anaemia
- thrombocytopenia

most cases are secondary
primary cases are due to complement dysregulation

Question 11

causes of secondary HUS

Answer 11

shigatoxin producing EColi 0157

pneumococcal infection
HIV
rare - SLE, cancer

Question 12

HUS investigations

Answer 12

FBC
- anaemia - <80
- thrombocytopenia
- fragmented blood film - schistocytes + helmet cells
*negative coombs test

U&Es - AKI

stool culture - PCR for shiga toxins

Question 13

management of HUS

Answer 13

supportive - fluids, blood transfusion, dialysis if required
NO antibiotics