Neonatal Jaundice

Question 1

Definition?

Answer 1

Jaundice is a common and usually harmless condition in newborn babies that causes yellowing of the skin and the whites of the eyes

Question 2

Common Cause?

Answer 2

> 50% new-borns become visibly jaundiced due to

• Physiological Hb release from RBC (high [Hb] at birth)
• Breast milk jaundice (only >24hrs)
• RBC lifespan of 70 days rather than 120 days in adults
• BR metabolism less efficient in 1st few days of life

Question 3

Pathological causes?

Answer 3

haemolytic anaemia, infection/sepsis, inborn error of metabolism, liver disease

unconjugated bilirubin - kernicterus

conjugated bilirubin - dark urine and pale stools

Question 4

Complications?

Answer 4

Kernicterus - encephalopathy due to high levels of unconjugated bilirubin in the blood.

symptoms - lethargy, irritability, increased muscle tone, seizures and coma

can develop into cerebral palsy, learning difficulties and sensorineural deafness

treated with phototherapy.

Question 5

Management?

Answer 5

phototherapy for UNCONJUGATED ONLY
(will make the child bronze if they have cBR and it should be stopped)

IVIG - if rhesus disease, or ABO incompatability

exchange transfusion + phototherapy + IVIG if there are signs of kernicterus

Question 6

Investigations?

Answer 6

< 24 hours check serum BR levels
>2 weeks split BR to check uBR and cBR

FOR underlying causes:

haematocrit
G6PD levels
TSH, LFTs
blood group
FBC

Question 7

How to asses?

Answer 7

Visual inspection in natural light

prolonged if >14 days term