Neonatal/Infant Jaundice - Neonatal sepsis, Hereditary spherocytosis, G6PD deficiency, Biliary atresia, Congenital hypothyroidism, TORCH, Physiological, Breastfeeding, Breastmilk Flashcards
Neonatal sepsis
-casusative organism
-risk factors
-why jaundice?
GBS - within 1st 72hrs of life
-transmitted from mother to neonate in delivery
Current maternal GBS colonisation
-prenatal screening
-current bateruria
-intrapartum temp 38C+
-membrane rupture 18hrs+
-current infection throughout pregnancy
Premature
Low birth weight (U2.5kg)
Maternal chorioamnionitis
Sepsis affects liver’s ability to break down conjugated bilirubin
Neonatal sepsis
-presentation
-investigations
-management
Resp distress
HighHR, apnoea
Change in MS, lethargy
Jaundice
Temp can vary - febrile <=> hypothermic
Symptoms relating to source of infection
FBC - can exclude healthy neonates
CRP
Blood gas - metabolic acidosis
Blood culture - establish diagnosis
Urine MCS if urinary source
LP if meningitis source
IV benpen + gent unless resistant
CRP remeasured in 18-24hrs to monitor progress and guide duration of therapy
-if U10 and -ve culture => stop ABx at 48hrs
-otherwise, guided by investigations and clinical picture
Supportive
-O2, fluids and electrolytes
-prevent and manage hypoglycemia, metabolic acidosis
Jaundice in the 1st 24hrs
-causes
ALWAYS PATHOLOGICAL
Hemolytic blood issues
-Rhesus hemolytic disease
-ABO hemolytic disease
-hereditary spherocytosis
-glucose 6 phosphodehydrogenase deficiency
Hereditary spherocytosis
-what is it
-presentation
-investigations
-management
AD defect of RBC cytoskeleton => sphere shaped RBC
-lifespan reduced as destroyed by spleen => non conjugated bilirubin rises
Northern EU
Failure to thrive
Jaundice, gallstones
Splenomegaly - as RBCs destroyed sooner
Aplastic crisis triggered by parvovirus infection
If FHx
-clinical picture
-lab results (spherocytes, high MCHC, high reticulocytes
If unclear => EMA binding and cryohemolysis test
Acute hemolytic crisis
-supportive
-transfuse if needed
Long term
-folate
-splenectomy
G6PD deficiency
-what is it
-presentation
-hemolysis triggering drugs
-investigations
-management
X linked defect
-low G6PD => increased red cell susceptibility to oxidative stress
Jaundince
Intravascular hemolysis
Gallstones
Splenomegaly
Heinz bodies - tiny red dots of hemoglobin
Bite and blister cells - spleen removes Heinz bodies
Antimalarials - primaquine
Ciprofloxacin
Sulph drugs
Infection
Fava beans
G6PD assay done after 3 months of acute hemolysis - prevent false negative results
Treat jaundice symptoms
-phototherapy
-exchange transfusion - remove affected blood, replace with healthy blood
Avoid triggering drugs and fava beans
Jaundice in 2-14days
-causes
Physiological
-babies are born with more Hb, gets broken down
-alongside developing liver function
Breastmilk jaundice
-breastmilk substance inhibits liver’s ability to conjugate bilirubin
Breastfeeding jaundice
-not enough breastmilk + greater absorption of conjugated bilirubin
-resolved with more breastfeeding
Prolonged jaundice in 14days+
-causes
Biliary atresia - high conjugated bilirubin
Hypothyroidism - high unconjugated bilirubin
-UTD activity low => harder to conjugate bilirubin
Prematurity - immature liver function
-prolonged jaundice defined at 3wks after birth
TORCH infections
Biliary atresia
-what is it
-presentation
-investigation
-management
-complications
Obliteration/discontinuation of extrahepatic biliary system => cholestasis
Jaundice beyond physiological 2wks
Dark urine, pale stool
Appetite, growth disturbance
Hepatosplenomegaly
Abnormal growth
LFT
-high conjugated bilirubin
-cholestatic picture
a1at deficiency
Sweat chloride test - CF often involves biliary tract
Biliary and liver US => distension, tract abnormalities
VITAL TO PICK UP WITHIN 2WEEKS => REQUIRES URGENT SURGERY
-if missed, must wait for transplant, there is no interim treatment
Definitive - surgical recontruction
Medical ABx and bile acid enhancers postop
Surgical failure, may need transplant
Progressive liver disease => cirrhosis, hepatocellular carcinoma
Congenital hypothyroidism
-why does this happen
-presentation
-screening
-management
Thyroid underdeveloped/,issing/not producing thyroxine
Prolonged neonatal jaundice
Delayed mental and physical milestones
Short
Puffy face, macroglossia
Hypotonia
Heel prick test 5-7days
Levothyroxine
TORCH infection
-what are they
-presentation
Toxoplasmosis
Other infections (HIV, parvovirus, varicella, Zika)
Rubella
CMV
Herpes
Can be passed onto baby via
-placental
-vaginal delivery
-breastfeeding
Common features
-fever, difficulty feeding
-jaundice
-low birth weight
-hearing impairment
-PDA
-purpura, blueberry rash
-hepatosplenomegaly
-cataracts
-microcephaly
