Neonatal Jaundice (1) Flashcards
What occurs in physiological jaundice?
→ When is this expected?
When does jaundice become pathological?
→ What needs to be done urgently in this case?
When does jaundice become prolonged?
→ What needs to be done urgently in this case?
➊ At birth, the baby undergoes a period where a huge amounts of HbF is destroyed, and lots of HbA is produced
• This normal process of breakdown creates a rise in bilirubin and mild jaundice
→ 2-7 days – This usually resolves in 10 days
➋ In first 24 hrs of life
→ Investigate for neonatal sepsis as it’s a common cause
➌ >14 days (>21 if preterm)
→ Investigate for biliary atresia, hypothyroidism, and G6PD deficiency
This can be increased by an increased production or decreased excretion of bilirubin. What are the causes of this?
Increased production of bilirubin:
• Haemolytic Disease of the Newborn (RhD -ve had a RhD +ve baby, then becomes pregnant with another RhD +ve baby)
• ABO incompatibility
• Haemorrhage
• Intraventricular haemorrhage
• Neonatal sepsis
• G6PD deficiency
Decreased excretion of bilirubin:
• Prematurity (They have an immature liver, which increases their risk of complications, like kernicterus)
• Breast milk jaundice - unconjugated (Affects the liver’s ability to process bilirubin for its excretion, and inadequate breastfeeding may slow passage of stools, therefore allowing more absorption of bilirubin back into blood)
• Biliary Atresia - conjugated
• Neonatal cholestasis
• Hypothyroidism
Which investigations should be done?
Determine the underlying cause:
• FBC and Blood film – Polycythaemia, Thrombocytopenia, Anaemia
• Blood group and Rhesus status of mother and baby
• DAT/Coombs test – For haemolysis
• LFTs
• G6PD levels
• Blood and Urine culture – Suspected neonatal sepsis
• TFTs
Management:
How is treatment decided?
What is the main treatment option?
What may be done if levels are extremely high?
➊ Total bilirubin levels are monitored on treatment threshold charts, with the baby’s age against the total bilirubin level – If level reaches threshold, treatment is started
➋ Phototherapy – Breaks down bilirubin into excretable components, which don’t require the liver to do anything
➌ Exchange transfusion
Kernicterus:
What occurs here?
→ Why does this happen?
What does this lead to?
How does it present?
➊ Severe complication of permanent brain damage due to excessive (unconjugated) bilirubin levels
→ Bilirubin can cross leaky BBB in neonates
➋ Cerebral palsy, LD, and Deafness
➌ • Less responsive
• Floppy
• More sleepy
• Poor feeding
N.B. Only unconjugated bilirubin can cross the BBB as it’s lipid-soluble
