Jaundice neonates CG98 Flashcards
What level of bilirubin (micromol/l) to start (A) phototherapy and (B) exchange transfusion at 0 hours and 12 hours and 24 hours and 96 hours after birth?
0 hours >100 photo AND exchange transfusion
12 hours >150 phototherapy, >200 exchange transfusion
24 hours >200 phototherapy, >300 exchange transfusion
96 hours+ >350 phototherapy, >450 exchange transfusion
RFs for hyperbilirinaemia
Gestation age <38w
Previous sibling requiring phototherapy
Exclusive breastfeeding
Visible jaundice in first 24 hrs life
How to measure bilirubin level?
For babies <24 hrs old or <35w prem, use serum bilirubin
For babies >35w gest age or >24 hrs old, use transcutaneous bilirubinometer, then use serum if above thresholds
Care during phototherapy?
Monitor temp and hydration
Encourage parents to interact and cuddle
Eye protection
What increases risk of kernicterus?
> 340 bilirubin
Rapidly rising bilirubin
Clinical features of bilirubin encephalopathy
What other Ix for underlying disease?
all babies:
Packed cell volume
Blood group
Coombs test
consider:
FBC
Glucose-6-phosphate dehydrogenase
Cultures of blood, urine, LP