Neonatal Jaundice

Question 1

What serious neological complication can result acutely from severe neonatal Jaundice?

Answer 1

Kernicterus or bilirubin encephalopathy

Question 2

Briefly describe pathophysiology of kernicterus?

Answer 2

Fat soluble unconjugated bilirubin crosses the BBB and deposits in the basal ganglia and hippocampus.

Question 3

List clinical features of kernicterus

Answer 3

Poor feeding
Irritability
Increased tone/ epistotonus
Long term developmental delay /CP

Question 4

List physiological reasons for neonatal Jaundice

Answer 4

• increased RBC mass
• increased RBC turnover-shorter life span of adult RBC
• immature liver - decreased hepatic uptake, conjugation and excretion of bilirubin
• increased interohepatic circulation of bilirubin

Question 5

What blood test on mom and baby would help in determining the cause of jaundice? Explain

Answer 5

Blood group and Coombs

• if mom is Rh-ve and baby Rh+ve >Rh hemolytic disease.
• if mom is Group O and baby Group A/B/AB >ABO incompatibility >haemolysis.

Question 6

List clinical features which would classify neonatal Jaundice as pathological.

Answer 6

• jaundice in the first 24hrs of life.
• jaundice persisting for > 2 weeks.
• conjugated hyperbilirubinaemia >20% direct or direct >34mmol/l (2g/dl)
• rapid increase in bilirubin >85mmol/day