Neonatal jaundice

Question 1

What is neonatal jaundice

Answer 1

> 50% of newborns are visibly jaundiced because of -physiological release from RBC (high HB at birth), RBC lifespan of 70 days (instead of 120), BR metabolism less efficient initially, Breast milk jaundice (after 24h)

Jaundice before 24h and after a few weeks needs investigation

uBR -deposits in basal ganglia- causes kenicterus (form of encelopatju_
death, lethargy, irritable, seizure, coma, arched back (increased muscle tone)
can develop dyskinetic cerebral paslty, learning difficulties or neural defects

was big issue due to rhesus disease of the new born

if visible jaudince over 80 - uBR -kenicterus, cBR-dark urine, pale stools

Ix- before 24h, tBR =uBR, blood films, transcut no good
<2weeks - transcuaneous BR -likely uBR, blood fil
Later -direct and undirect (check if uBR or cBR

Mx - phototherapy (converts uBR tp lumirubin and photorubin), IVIG and exchange transfusion

Question 2

What are the causes of Neonatal jaudice in 1st 24h of life (and Ix needed)

Answer 2

ALWAYS ABNORMAL
Usually going to be uBR caused - Transcut not useful, blood film, Coombs test

heamolysis cause or metabolic cause

Infection and Rhesus disease are the big heamolytic causes -DAT+

Heamolysis due to ABO/rhD incopability
Heamolysis due to metabolic disorder (G6PDD, PK def, hereditary spherocytosis)

MEtabolic -gilberts + infectious trigger, crigller najjar, DAT -

Question 3

What are the causes of Neonatal jaudice in 24h-2weeks of life (and Ix needed)

Answer 3

Transcutaneous -interpret at uBR, blood film
only uBR causes

Physio jaudunce (40-60%) -immature liver, peaks at 3-5d
BReastfeeding jaundice -10%- less milk intake-> more enterohepatic recylcing of BR
Breastmilk jaudice - decreased enzyme activity (occurs AFTER physiological)
Metabolic -same causes as under 24
Heamolysis - less likely to be ABO/RhD caused now (congenital G6PDDetc more)
Infection
congenital hypothyroidism

Question 4

What are the causes of Neonatal jaudice in >2 weeks of life (and Ix needed)

Answer 4

direct (uBR and indirect)

uBR predominant
can be any of the other causes ongoing (breast milk and physio most common)
pyloric stenosis -present at 2-4w
congenital hypothyroidism

cBR predominant
Congenital hypothyroidism, Hypopit
Biliary atresia (can be asympto + jaundice and pale stools)
inherited metabolic
Ascednding cholangitis
cystic fibrosis
Idiopathic neonatal hepatitis