neonatal jaundice

Question 1

what is jaundice

Answer 1

yellowing of the skin and sclera

Question 2

what causes jaundice physiologically

Answer 2

due to high levels of bilirubin in blood

Question 3

is the pathological or physiological in new borns

Answer 3

mainly physiological

Question 4

-

Answer 4

-

Question 5

what is gliberts disease

Answer 5

certain enzyme abnormalities which affects conjugation
mutation of UGT1A1 gene - reduces bilirubin uridine diphosphate glucuronosyltransferase by around30% (bilirubin-UGT) and can make jaundice worse

Question 6

what can bilirubin crossing the BBB cause

Answer 6

encephalopthay which can lead to kernicterus

Question 7

what is there a small risk of with high levels of bilirubin

Answer 7

cerebral palsy

Question 8

what hours of birth is jaundice become pathological?

Answer 8

if still occuring late >14 weeks in term and 21 days in preterm
due to haemolysis, sepsis, metabolic disorders, liver disease

Question 9

why does physiological jaundice develop?

Answer 9

increased productino; foetal RBC life span 2/3 of adults, high hct, brusing
decreased uptake and binding by liver cells
decreased conjugation
decreased excretion
increased enterohepatic circulation of bilirubin

Question 10

to early jaundice is almost always pathological, what is this due to?

Answer 10

haemolysis, with excessive production of bilirubin, sepsis could be an underlying cause

Question 11

when can babies be born with jaundice

Answer 11

severe haemolysis

hepatits

Question 12

causes of haemolysis

Answer 12

ABO incompatibility
Rh immunisation
sepsis

Question 13

how do you investigate early pathological jaundice?

Answer 13

total bilirubin conc (SBR)
maternal blood group and antibody titres (if Rh neg)
baby blood group, direct agglutination test, elution test to detect antiA or antiB antibodies on babys red cells
FBC - evidence of haemolysis
CRP - infection?

Question 14

haemolysis investigations

Answer 14

blood group incompatibility (commonly with rhesus or ABO) identified with a positive direct agglutination test (DAT)or due to a glucose 6 phosphate dehydrogenase deficiency

Question 15

haemolysis investigations

Answer 15

blood group incompatibility (commonly with rhesus or ABO) identified with a positive direct agglutination test (DAT)or due to a glucose 6 phosphate dehydrogenase deficiency

Question 16

features of bilirubin encephalopathy

Answer 16

lethargy
poor feeding
temp instability
hypotonia
arching of the head, neck, and back
spasticity
seizure

Question 17

causes of SBR being too high

Answer 17

mild dehydration/insufficient milk supply
breakdown of extravasated blood
haemolysis
infection
increased enterohepatic circulation

Question 17

causes of SBR being too high

Answer 17

mild dehydration/insufficient milk supply
breakdown of extravasated blood
haemolysis
infection
increased enterohepatic circulation

Question 18

causes of persistent unconjugated hyperbilirubinaemia

Answer 18

breast milk jaundice
poor milk intake
haemolysis
infection
hypothyroidism

Question 19

causes of persistent conjugated hyperbilirubinaemia

Answer 19

hepatitis - infection or metabolic disorders

biliary atresia - pale stools dark urine, surgery with a kasai portoenterostomy before 3 months of age

Question 20

causes of persistent unconjugated hyperbilirubinaemia

Answer 20

hypothyroidism - persistent jaundice is the earliest sign
breast milk jaundice - normal conjugated portion, normal FBC and blood group to exclude haemolysis, no sign of infection UTI, thriving, reassurance

Question 21

treatment of jaundice

Answer 21

treat cause
adequate feeding
enteral feeding is best in order to reduce enterohepatic circulation of bilirubin
PHOTOTHERAPY - bluelight
exchange transfusion for haemolytic disease
IV IMMUNOGLOBULIN with imfants with isoimmune haemolytic disease and rising bilirubin despite intensive phototherapy

Question 22

onset day 1, peak variable, prolonged after day 14

symptoms and signs of aetiological cause eg lethargy for sepsis; pale stool for hepatitis

Answer 22

likely pathological

Question 23

onset day 2
peak day 5
resolve day 10-14
otherwise well

Answer 23

physiological