Neonatal Jaundice Flashcards
What is neonatal jaundice?
A yellowish discolouration of the white parts of the eyes and skin in a newborn baby due to excess bilirubin levels
When is jaundice more likely to have a serious underlying cause?
Any jaundice presenting in the first 24 hours of life
Give 3 examples of serious underlying causes of jaundice presenting in the first 24 hours?
- Infection
- Haemolytic disease
- Metabolic disorders
Why are bilirubin levels higher in neonates than in adults?
Because newborn babies have a higher concentration of RBCs, which also have a shorter lifespan
What does RBC breakdown create?
Unconjugated bilirubin
How does unconjugated bilirubin circulate?
Mostly bound to albumin
What is unconjugated bilirubin metabolised by?
The liver
What does the metabolism of unconjugated bilirubin in the liver produce?
Conjugated bilirubin
What happens to conjugated bilirubin?
It is excreted in the stool
What are the categories of neonatal jaundice?
- Physiological jaundice
- Early neonatal jaundice
- Prolonged jaundice
- Conjugated hyperbilirubinaemia
What is considered to be early neonatal jaundice?
Onset less than 24 hours
What is prolonged neonatal jaundice?
Jaundice lasting for more than 14 days in term infants, and 21 days in pre-term
What does physiological jaundice result from?
Increased erythrocyte breakdown and immature liver function
What can cause early neonatal jaundice?
- Haemolytic disease
- Infection
- Increased haemolysis due to haematoma
- Maternal autoimmune haemolytic anaemia
- Crigler-Najjar syndrome or Dublin-Johnson syndrome
- Gilbert’s syndrome
Give an example of a cause of haemolytic disease leading to early neonatal jaundice?
Haemolytic disease of the newborn
Give 3 examples of causes of infection that can lead to early neonatal jaundice
- Congenital infections
- Herpes simplex
- Postnatal infection
Give an example of a maternal autoimmune haemolytic anaemia that can lead to early neonatal jaundice
SLE
What are the causes of prolonged neonatal jaundice?
- Infection
- Hypothyroidism or hypopituitarism
- Galactosaemia
- Breast milk jaundice
- GI causes
Give an example of an infection that can cause prolonged neonatal jaundice
UTI
Give 3 GI causes of prolonged neonatal jaundice
- Biliary atresia
- Choledochal cyst
- Neonatal hepatitis
What are the causes of conjugated hyperbilirubinaemia in neonates?
- Infection
- Parenteral nutrition
- Cystic fibrosis
- Metabolic disorders
- GI causes
- Endocrine causes
Give 2 metabolic disorders that can cause conjugated hyperbilirubinaemia in neonates
- Alpha-1-antitrypsin deficiency
- Galactosaemia
Give 3 GI causes of conjugated hyperbilirubinaemia in neonates?
- Biliary atresia
- Choledochal cyst
- Hepatitis
Give 2 examples of endocrine causes of conjugated hyperbilirubinaemia in neonates
- Hypothyroidism
- Hypopituitarism
What are the risk factors for neonatal jaundice?
- Low birth weight
- Breast-fed babies
- Previous sibling with neonatal jaundice requiring phototherapy
- Visible jaundice in first 24 hours
- Infants of mothers with diabetes
- Male gender
- East Asians
Where does neonatal jaundice first become visible?
In the face and forehead
How is the underlying colour revealed in neonatal jaundice?
Blanching
How does the distribution of neonatal jaundice progress?
It gradually becomes visible on the trunk and extremities
What is true of physical examination in most infants with neonatal jaundice?
Yellow colour is the only finding on physical examination
What may more severe cases of neonatal jaundice be associated with?
Drowsiness
Why should other signs be looked out for when assessing neonatal jaundice?
As they may be associated with an underlying cause
What is usually the only testing required in neonatal jaundice?
A total serum bilirubin
When is further investigation essential in neonatal jaundice?
For any baby who is unwell, presents in the first 24 hours, or has prolonged (10 days) jaundice
What further investigations may be done in jaundice?
- LFTs
- Infection screen
- Haemolysis tests
- TFTs
What haemolysis tests may be done in neonatal jaundice?
- Blood type and Rh determination of mother and infant
- Reticulocyte count
- Direct Coomb’s test
What is involved in the basic management of neonatal jaundice? -
- Monitoring of bilirubin levels
- Treatment of underlying cause
- Increase in fluid intake
How is an increase in fluid intake achieved in neonatal jaundice?
Usually oral, but may require IV fluids depending on cause and well-being of baby
What are the further management options for neonatal jaundice?
- Phototherapy
- Exchange transfusion
- IV immunoglobulin
What are the indications for phototherapy dependant on in neonatal jaundice?
- Serum bilirubin
- Gestation of the baby
- Rate of rise of bilirubin
- Likely underlying cause
- Well-being of the baby
When should you refer an infant with neonatal jaundice for urgent hospital assessment?
- If jaundice presents in first 24 hours of life
- If baby is jaundiced and unwell
- Prolonged jaundice
What is an important complication of neonatal jaundice?
Kernicterus
