jaundice in the newborn + febrile convulsions Flashcards
biliary atresia
obliteration/discontinuity within biliary system -> obstruction of bile flow
cholestasis from birth-8wks
rare
biliary atresia presentation
first few weeks of life-
- jaundice (extending beyonf physiological 2 weeks)
- dark urine + pale stool
- appetite + growth disturbance
jaundice in first 24hrs
ALWAYS PATHOLOGICAL
Causes of jaundice in first 24hrs
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase
always pathological
jaundice in neonate from 2-14days
common (40%) + usually physiological
- due to more RBCs, more fragile cells + less developed liver function
commoner in breastfed babies
jaundice after 14days (21days if premature)
= prolonged
jaundice screen is preformed
prolonged jaundice screen
- conjugated + unconjugated bilirubin
- direct antiglobulin test (Coombs)
- TFTs
- FBC + blood film
- urine for MC&S + reducing sugars
- U&Es + LFTs
what could a raised conjugated bilirubin in prolonged jaundice indicate
biliary atresia ! requires urgent surgical intervention
causes of prolonged jaundice
biliary atresia
hypothyroidism - impacts livers ability to conjugate bilirubin
galactosaemia
UTI
breast milk jaundice
prematurity - immature liver function, increased risk of kernicterus
congenital infections - CMV, toxoplasmosis
Gilberts syndrome
inherited cause of jaundice
unconjugated hyperbilirubinaemia
autosomal recessive
mild deficiency of UDP-glucuronyl transferase
benign
febrile convulsions
seizures provoked by fever in otherwise normal kids
occur between ages 6months - 5years
febrile convulsions features
usually occur early in a viral infection as temp rises rapidly
seizures are brief, lasting <5mins
tonic clonic
simplex febrile convulsion
<15mins
generalised seizure
no recurrence within 24hrs
should be complete recovery within an hour
complex febrile convulsions
15-30mins
focal seizure
may have repeat seizures within 24hrs
febrile status epilepticus
> 30mins
admission following febrile convulsion
kids who have had first seizure OR any features of a complex seizure should be admitted to paeds
management of febrile convulsion
parents should be advised to phone an ambulance is seizure lasts >5mins
- regular antipyretics have NOT been shown to reduce the chance of febrile seizure
in recurrent febrile convulsions, what rescue medication can be given
benzodiazepine rescue med
- rectal diazepam or buccal midazolam
under specialist advice only
febrile convulsion link to epilepsy
RF - fam hx, complex febrile seizures, background neurodevelopmental disorder
no risk factors = 2.5% risk
risk factors for having further febrile convulsions
1 in 3
risk factors
- age of onset <18months
- fever <39
- shorter duration of fever before seizure
- fam hx of febrile convulsions
