Neonatal Jaundice

Question 1

why are babies prone to jaundice?

-3

Answer 1

↑RBC breakdown

undeveloped Liver

not feeding so conjugated bilirubin just stays in gut then gets resorbed into blood

Question 2

which type of bilirubin is that usually builds up in neonates?

Answer 2

↑unconjugated bilirubin

Question 3

why is ↑unconjugated bilirubin a danger in neonates?

Answer 3

brain damage

Question 4

what is this brain damage called?

Answer 4

kernicterus

Question 5

why is it that unconjugated bilirubin can cause brain damage?

Answer 5

can cross unformed BBB

Question 6

how longer after birth does it take for BBB to form?

Answer 6

7 days

Question 7

Why is there ↑RBC breakdown?

Answer 7

in utero baby has very high foetal Hb to compensate for utero environment > once delivered no longer needs the high RBC > so breaks it down

Question 8

After 7 days the danger posed by high bilirubin decreases, why?

Answer 8

BBB has now formed

Question 9

Classifications of neonatal jaundice?

-4

Answer 9

Physiological

Early unconjugated

Late unconjugated

Late conjugated

Question 10

define early unconjugated vs late unconjugated jaundice?

i.e. what is meant by early and late

Answer 10

Early unconjugated - < 7 days

Late unconjugated - > 7 days

Question 11

Late conjugated jaundice; how will stools look? (colour)

Answer 11

white

Question 12

what is the most rare type/class of neonatal jaundice?

Answer 12

Late conjugated

Question 13

% wise how rare is late conjugated?

Answer 13

1%

Question 14

Physiological jaundice usually takes how long before it comes on?

Answer 14

after 48 hours

Question 15

of the pathological jaundices, which is most common, unconjugated or conjugated?

Answer 15

unconjugated

Question 16

jaundice pre 24 hours tells you what about classification?

Answer 16

pathological; early unconjugated

Question 17

if jaundice pre 24, what should you check?

-3

Answer 17

check Rhesus status
sepsis
Direct Comb test

Question 18

Physiological Jaundice Features?

-6

Answer 18

Unconjugated bilirubin not too high

Healthy term infant

Appears after 48 hours

Lasts 1-2 weeks

Question 19

cause of physiological jaundice?

Answer 19

↑RBC breakdown + immature liver

Question 20

main treatment for physiological jaundice?

Answer 20

NO Treatment

Question 21

what can common RF can exacerbate physiological jaundice?

Answer 21

dehydration

Question 22

Early unconjugated jaundice causes can all be put under what umbrella condition?

thus what test will be positive on all these causes?

Answer 22

Haemolytic Anaemias

all +veDCT

Question 23

Direct Coomb test check for what?

Answer 23

checks for haemolytic antibodies in babies blood

Question 24

which drugs can cause early unconjugated jaundice?

Answer 24

sulphonamides, anti-malarial drug

Question 25

which enzyme deficiencies can cause early unconjugated jaundice?

Answer 25

G6PD deficiency Pyruvate Kinase deficiency

Question 26

G6PD normal function?

Answer 26

G6PD naturally protects RBC from oxidative damage

Question 27

Pyruvate Kinase normal function? how will deficiency in this enzyme cause haemolysis?

Answer 27

PK makes glucose , if no glucose in RBC, RBC breaks down

Question 28

which RBC malformation can cause early unconjugated jaundice? treatment for this?

Answer 28

Spherocytosis remove spleen

Question 29

what other diseases can cause early unconjugated jaundice? | -3

Answer 29

Rhesus disease ABO not compatible Polycythaemia

Question 30

define polycythaemia

Answer 30

↑ RBC

Question 31

what diseases can cause late unconjugated jaundice? | -4

Answer 31

Crigler Najjar Gilberts Hypothyroidism Galactosemia

Question 32

why is hypothyroidism and jaundice a bad mix?

Answer 32

long term ↓T4 causes brain damage

Question 33

what condition can cause conjugated jaundice in neonates? | -1

Answer 33

Biliary atresia

Question 34

main Ix for biliary atresia?

Answer 34

US

Question 35

name of surgery for biliary atresia?

Answer 35

Kasai procedure

Question 36

what happens in Kasai procedure?

Answer 36

attach small intestine to Liver

Question 37

iatrogenic cause of conjugated jaundice in neonates?

Answer 37

TPN

Question 38

why does TPN cause conjugated jaundice?

Answer 38

bile ducts get blocked > cholestatic conjugated bilirubin

Question 39

usual Mx for TPN caused conjugated jaundice?

Answer 39

resolves by self

Question 40

neonate has jaudnice. what question do you ask in HX?

Answer 40

``` When did it start? Term? FhX? E+D? Drugs? Mum’s ABO and Rhesus status? Colour of urine/stool? Opening Bowels ```

Question 41

on examination; what is a sign of brain damage you should look for?

Answer 41

hypotonia

Question 42

on examination what other signs should you be looking for?

Answer 42

clinical signs of dehydration RDS (↑RR, grunt, recession) shock (↑HR, ↑CR, poor perfusion

Question 43

if there is hypotonia what dose this tell you about disease progression?

Answer 43

brain damage already done; late stage

Question 44

you examine a baby with suspected jaundice. what do you look for in the eyes? -2 what does each sign tell you?

Answer 44

Sclera = yellow (jaundice). Conjunctiva = pale (anaemia, cyanosis)

Question 45

routine bloods for a neonate with jaundice?

Answer 45

``` SBR Hb Blood groups sepsis Ix (lactate, culture) DCT ```

Question 46

mainstay Mx for neonatal jaundice?

Answer 46

phototherapy

Question 47

how does phototherapy work?

Answer 47

makes unconjugated bilirubin aqueous

Question 48

if you do phototherapy on a baby with conjugated bilirubin, what will happen?

Answer 48

skins goes tanned

Question 49

2nd line Mx?

Answer 49

ADD Exchange Transfusion

Question 50

how does threshold for phototherapy change with age?

Answer 50

increased age = increased threshold

Question 51

how you check if jaundiced baby meets threshold for phototherapy?

Answer 51

take SBR and plot on graph

Question 52

main indication for exchange transfusion?

Answer 52

really high bilirubin levels