Jaundice_Newborn_Flashcards
Is jaundice in the first 24 hours of a newborn’s life pathological or physiological?
Jaundice in the first 24 hours is always pathological.
What are some causes of jaundice in the first 24 hours of a newborn’s life?
Causes of jaundice in the first 24 hours include rhesus haemolytic disease, ABO haemolytic disease, hereditary spherocytosis, and glucose-6-phosphodehydrogenase deficiency.
How common is jaundice in the neonate from 2-14 days, and what is it usually due to?
Jaundice in the neonate from 2-14 days is common (up to 40%) and usually physiological, due to more red blood cells, more fragile red blood cells, and less developed liver function.
Is jaundice more commonly seen in breastfed or formula-fed babies in the neonate from 2-14 days?
Jaundice is more commonly seen in breastfed babies in the neonate from 2-14 days.
What should be done if there are signs of jaundice after 14 days (21 days if premature)?
If there are still signs of jaundice after 14 days (21 days if premature), a prolonged jaundice screen is performed.
What is the most important test in a prolonged jaundice screen?
The most important test in a prolonged jaundice screen is measuring conjugated and unconjugated bilirubin.
What could a raised conjugated bilirubin indicate in a newborn with prolonged jaundice?
A raised conjugated bilirubin could indicate biliary atresia, which requires urgent surgical intervention.
What are some causes of prolonged jaundice in newborns?
Causes of prolonged jaundice include biliary atresia, hypothyroidism, galactosaemia, urinary tract infection, breast milk jaundice, prematurity, and congenital infections (e.g., CMV, toxoplasmosis).
Why is jaundice more common in breastfed babies?
Jaundice is more common in breastfed babies due to high concentrations of beta-glucuronidase, which increase intestinal absorption of unconjugated bilirubin.
Why is prematurity a cause of prolonged jaundice in newborns?
Prematurity is a cause of prolonged jaundice due to immature liver function.
What are the risks associated with prematurity and jaundice?
The risks associated with prematurity and jaundice include an increased risk of kernicterus.
What congenital infections can cause prolonged jaundice in newborns?
Congenital infections that can cause prolonged jaundice include CMV and toxoplasmosis.
summarise newborn jaundice
Jaundice in the newborn period
Jaundice in the first 24 hours
Jaundice in the first 24 hours is always pathological.
Causes of jaundice in the first 24 hrs
rhesus haemolytic disease
ABO haemolytic disease
hereditary spherocytosis
glucose-6-phosphodehydrogenase
Jaundice in the neonate from 2-14 days
Jaundice in the neonate from 2-14 days is common (up to 40%) and usually physiological. It is due to a combination of factors, including more red blood cells, more fragile red blood cells and less developed liver function.
It is more commonly seen in breastfed babies
Jaundice after 14 days (prolonged)
If there are still signs of jaundice after 14 days (21 days if premature) a prolonged jaundice screen is performed, including:
conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention
direct antiglobulin test (Coombs’ test)
TFTs
FBC and blood film
urine for MC&S and reducing sugars
U&Es and LFTs
Causes of prolonged jaundice
biliary atresia
hypothyroidism
galactosaemia
urinary tract infection
breast milk jaundice
jaundice is more common in breastfed babies
mechanism is not fully understood but thought to be due to high concentrations of beta-glucuronidase → increase in intestinal absorption of unconjugated bilirubin
prematurity
due to immature liver function
increased risk of kernicterus
congenital infections e.g. CMV, toxoplasmosis
You are asked to see a baby on the post-natal ward 10 hours post vaginal delivery. The midwife informs you that the mother was positive for group B streptococcus. On examination you note a yellow discolouration to the skin. What is the next most appropriate action to take?
Measure serum bilirubin within 2 hours
Measure serum bilirubin within 6 hours
Measure bilirubin via transcutaneous bilirubinometer
Start empirical phototherapy
Reassess after 24 hours of age
Measure serum bilirubin within 2 hours
As this baby is less than 24 hours old they are high risk for developing severe hyperbilirubinaemia and must have their serum bilirubin urgently (within 2 hours). As this baby is less than 24 hours old the use of a transcutaneous bilirubinometer is inappropriate. Phototherapy is a treatment option for jaundice, but a serum bilirubin should be measured in case it is beyond the threshold for exchange transfusion.
Reference: NICE Guideline CG98: Jaundice in newborn babies under 28 days
