Neonatal Conditions Flashcards
What does phototherapy do in a newborn with jaundice?
UV light breaks down bilirubin to biliverdin which is excreted in the kidneys
What are the main causes of unconjugated hyper-bilirubinaemia?
- Prematurity
- Rhesus incompatibility
- ABO incompatibility
- Infection
- Brusing
- Hypothyroidism
- Breast milk jaundice
- Physiological
What are the main causes of conjugated hyper-bilirubinaemia?
- Hepatitis
- Biliary atresia
- CF
- Choledocal cyst
What tests would you perform in neonatal jaundice?
- SBR
- FBC
- Group and Coomb’s
- Thyroid function
- TORCH screen
- Liver ultrasound
- Infection screen
- Liver isotope scan
- Coagulation
What would you need to obtain for a history of neonatal jaundice?
- At what age did it begin - <24hrs of birth requires investigation
- Risk factors for infection
- Family history - CF, spherocytosis
- Is the baby alert, active and feeding well or the opposite?
How would you perform an examination on a jaundiced baby?
- Extent of jaundice
- Other features of congenital viral infection: anaemia, petechiae, hepatosplenomegaly
- Dehydration - established breast-feeding?
- Signs of other infection
- Stool - pale stool = obstructive jaundice
What steps would you take in order to manage neonatal jaundice?
- Identify cause and severity of jaundice
- <24hrs birth, SBR, FBC, TORCH and then phototherapy if SBR > treatment line or rising fast
- > 24hrs: low SBR = observation. high SBR = Blood tests then phototherapy
- Prolonged jaundice - total and conjugated SBR = blood tests plus obstruction investigations. Also coagulation screen and Vit K supplements
What is Kernicterus?
Deposits of unconjugated bilirubin in the basal ganglia of the brain.
- Causes acute encephalopathy with irritability, high-pitched cry or coma
- Neurotoxic damage can lead to athetoid cerebral palsy
How would you treat neonatal jaundice?
- Phototherapy
- Transfusion if Rh to remove mother’s IgG antibodies from circulation
What is breast milk jaundice?
- Inhibition of liver conjugation enzymes by substances in breast milk
- Rule out all other causes before this
What is biliary atresia?
- Rare condition
- Absence of intra- or extrahepatic bile ducts
Develop conjugated hyperbilirubinaemia
What is the Kasai Procedure?
- Hepatoporto-enterostomy
- If biliary atresia detected within first 6 weeks of life
- Surgical method to bypass biliary ducts
Name 3 risk factors for birth Asphyxia
- Cord prolapse/impaction
- Placental abruption
- Drop in maternal BP
What can severe asphyxia cause?
Hypoxic Ischaemic Encephalopathy
Name 5 types of birthmark?
- Stork mark
- Port wine stain
- Strawberry nevus
- Mongolian blue spot
- Pigmented nevus
