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Paediatrics > Neonatal Jaundice > Flashcards

Neonatal Jaundice Flashcards

1
Q

why are babies prone to jaundice?

-3

A

↑RBC breakdown

undeveloped Liver

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

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2
Q

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

A

↑unconjugated bilirubin

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3
Q

why is ↑unconjugated bilirubin a danger in neonates?

A

brain damage

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4
Q

what is this brain damage called?

A

kernicterus

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5
Q

why is it that unconjugated bilirubin can cause brain damage?

A

can cross unformed BBB

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6
Q

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

A

7 days

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7
Q

Why is there ↑RBC breakdown?

A

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

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8
Q

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

A

BBB has now formed

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9
Q

Classifications of neonatal jaundice?

-4

A

Physiological

Early unconjugated

Late unconjugated

Late conjugated

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10
Q

define early unconjugated vs late unconjugated jaundice?

i.e. what is meant by early and late

A

Early unconjugated - < 7 days

Late unconjugated - > 7 days

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11
Q

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

A

white

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12
Q

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

A

Late conjugated

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13
Q

% wise how rare is late conjugated?

A

1%

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14
Q

Physiological jaundice usually takes how long before it comes on?

A

after 48 hours

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15
Q

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

A

unconjugated

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16
Q

jaundice pre 24 hours tells you what about classification?

A

pathological; early unconjugated

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17
Q

if jaundice pre 24, what should you check?

-3

A

check Rhesus status
sepsis
Direct Comb test

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18
Q

Physiological Jaundice Features?

-6

A

Unconjugated bilirubin not too high

Healthy term infant

Appears after 48 hours

Lasts 1-2 weeks

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19
Q

cause of physiological jaundice?

A

↑RBC breakdown + immature liver

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20
Q

main treatment for physiological jaundice?

A

NO Treatment

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21
Q

what can common RF can exacerbate physiological jaundice?

A

dehydration

22
Q

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

thus what test will be positive on all these causes?

A

Haemolytic Anaemias

all +veDCT

23
Q

Direct Coomb test check for what?

A

checks for haemolytic antibodies in babies blood

24
Q

which drugs can cause early unconjugated jaundice?

A

sulphonamides, anti-malarial drug

25
Q

which enzyme deficiencies can cause early unconjugated jaundice?

A

G6PD deficiency

Pyruvate Kinase deficiency

26
Q

G6PD normal function?

A

G6PD naturally protects RBC from oxidative damage

27
Q

Pyruvate Kinase normal function?

how will deficiency in this enzyme cause haemolysis?

A

PK makes glucose

, if no glucose in RBC, RBC breaks down

28
Q

which RBC malformation can cause early unconjugated jaundice?

treatment for this?

A

Spherocytosis

remove spleen

29
Q

what other diseases can cause early unconjugated jaundice?

-3

A

Rhesus disease

ABO not compatible

Polycythaemia

30
Q

define polycythaemia

A

↑ RBC

31
Q

what diseases can cause late unconjugated jaundice?

-4

A

Crigler Najjar

Gilberts

Hypothyroidism

Galactosemia

32
Q

why is hypothyroidism and jaundice a bad mix?

A

long term ↓T4 causes brain damage

33
Q

what condition can cause conjugated jaundice in neonates?

-1

A

Biliary atresia

34
Q

main Ix for biliary atresia?

A

US

35
Q

name of surgery for biliary atresia?

A

Kasai procedure

36
Q

what happens in Kasai procedure?

A

attach small intestine to Liver

37
Q

iatrogenic cause of conjugated jaundice in neonates?

A

TPN

38
Q

why does TPN cause conjugated jaundice?

A

bile ducts get blocked > cholestatic conjugated bilirubin

39
Q

usual Mx for TPN caused conjugated jaundice?

A

resolves by self

40
Q

neonate has jaudnice.

what question do you ask in HX?

A 
When did it start? 
Term? 
FhX? 
E+D? 
Drugs? 
Mum’s ABO and Rhesus status? 
Colour of urine/stool? Opening Bowels
41
Q

on examination;

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

A

hypotonia

42
Q

on examination what other signs should you be looking for?

A

clinical signs of dehydration

RDS (↑RR, grunt, recession)

shock (↑HR, ↑CR, poor perfusion

43
Q

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

A

brain damage already done; late stage

44
Q

you examine a baby with suspected jaundice.

what do you look for in the eyes?
-2

what does each sign tell you?

A

Sclera = yellow (jaundice).

Conjunctiva = pale (anaemia, cyanosis)

45
Q

routine bloods for a neonate with jaundice?

A 
SBR
Hb
Blood groups
 sepsis Ix (lactate, culture)
DCT
46
Q

mainstay Mx for neonatal jaundice?

A

phototherapy

47
Q

how does phototherapy work?

A

makes unconjugated bilirubin aqueous

48
Q

if you do phototherapy on a baby with conjugated bilirubin,

what will happen?

A

skins goes tanned

49
Q

2nd line Mx?

A

ADD Exchange Transfusion

50
Q

how does threshold for phototherapy change with age?

A

increased age = increased threshold

51
Q

how you check if jaundiced baby meets threshold for phototherapy?

A

take SBR and plot on graph

52
Q

main indication for exchange transfusion?

A

really high bilirubin levels

Paediatrics (30 decks)

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