Neonatal Jaundice

Question 1

What is jaundice?

Answer 1

The condition of abnormally high levels of bilirubin in the blood.

Question 2

What are the causes of neonatal jaundice divided into?

Answer 2

Increased production and decreased clearance

Question 3

What are causes of increased production of bilirubin?

Answer 3

• Haemolytic disease of the newborn
• ABO incompatibility
• Haemorrhage
• Intraventricular haemorrhage
• Cephalo-haematoma
• Polycythaemia
• Sepsis and disseminated intravascular coagulation
• G6PD deficiency

Question 4

What are the causes of decreased clearance of bilirubin?

Answer 4

• Prematurity
• Breast milk jaundice
• Neonatal cholestasis
• Extrahepatic biliary atresia
• Endocrine disorders (hypothyroid and hypopituitary)
• Gilbert syndrome

Question 5

What happens in premature babies due to an immature liver?

Answer 5

The process of jaundice is exaggerated

Question 6

What is there an increased risk of in premature babies due to the immature liver?

Answer 6

Kernicterus

Question 7

What is kernicterus?

Answer 7

Brain damage due to high bilirubin levels.

Question 8

Which babies are more likely to have jaundice?

Answer 8

Breast fed babies

Question 9

What are the potential reasons why breast fed babies are more likely to experience jaundice?

Answer 9

• Components of breast milk inhibit the ability of the liver to process the bilirubin.
• Breastfed babies are more likely to become dehydrated if not feeding adequately.
• Inadequate breastfeeding may lead to slow passage of stools, increasing absorption of bilirubin in the intestines.

Question 10

What do components of breast milk have the ability to do?

Answer 10

Inhibit the ability of the liver to process the bilirubin.

Question 11

What can inadequate breastfeeding lead to?

Answer 11

Slow passage of stools, increasing absorption of bilirubin in the intestines.

Question 12

What is the cause of jaundice in the first 24 hours?

Answer 12

Pathological

Question 13

What are the possible causes of jaundice in the first 24 hours?

Answer 13

• rhesus haemolytic disease
• ABO haemolytic disease
• hereditary spherocytosis
• glucose-6-phosphodehydrogenase

Question 14

What might babies with jaundice need in the first 24 hours?

Answer 14

Treatment for sepsis if they have any other clinical features or risk factors.

Question 15

When is jaundice common in a neonate?

Answer 15

Jaundice in the neonate from 2-14 days

Question 16

What is usually the cause of jaundice in the neonate from day 10-14?

Answer 16

Physiological

Question 17

What factors contribute to jaundice in the neonate from day 10-14?

Answer 17

• more red blood cells
• more fragile red blood cells
• less developed liver function.

Question 18

Who is jaundice at day 10-14 commonly seen in?

Answer 18

Breast fed babies

Question 19

What is Jaundice after 14 days in a neonate called?

Answer 19

Prolonged jaundice

Question 20

What is preformed if there is still jaundice after 14 days?

Answer 20

Prolonged jaundice screen

Question 21

What investigations might you carry out in a neonate with prolonged jaundice?

Answer 21

• conjugated and unconjugated bilirubin:
• direct antiglobulin test (Coombs’ test)
• TFTs
• FBC and blood film
• urine for MC&S and reducing sugars
• U&Es and LFTs

Question 22

What are possible causes of prolonged jaundice?

Answer 22

• biliary atresia
• hypothyroidism
• G6PD deficiency
• galactosaemia

Question 23

What are the other possible causes of prolonged jaundice?

Answer 23

Breastfed babies
Prematurity
Congenital infection

Question 24

Which congenital infections can cause neonatal jaundice?

Answer 24

CMV

Toxoplasmosis

Question 25

How can prematurity increase the risk of prolonged jaundice?

Answer 25

Immature liver

Increased risk of kernicterus

Question 26

What is the management of a child with neonatal jaundice?

Answer 26

Phototherapy is usually adequate to correct neonatal jaundice.

Question 27

What might extremely high levels of bilirubin indicate?

Answer 27

Extremely high levels of may require an exchange transfusion- removing blood from the neonate and replacing it with donor blood.

Question 28

What is the function of phototherapy?

Answer 28

Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver

Question 29

What is the function of phototherapy?

Answer 29

Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver

Question 30

When does physiological jaundice tend to occur?

Answer 30

Day 2-7

Question 31

When does physiological jaundice tend to resolve?

Answer 31

Day 10

Question 32

How can a child with physiological jaundice present?

Answer 32

Yellowing of skin and sclera

Question 33

What is physiological jaundice due to?

Answer 33

Fetal red blood cells break down more rapidly than normal red blood cells, releasing lots of bilirubin

Question 34

When can breast milk jaundice occur?

Answer 34

24 hours to 2 weeks after birth

Question 35

When is jaundice classified as abnormal?

Answer 35

• Jaundice is abnormal if:
  
  • it occurs within first 24 hours after birth
  • it lasts >14 days in full term babies
  • it lasts >21 days in premature babies

Question 36

What are the possible causes of early jaundice? (Less than 24 hours )

Answer 36

• rhesus haemolytic disease
• ABO haemolytic disease
• hereditary spherocytosis
• glucose-6-phosphodehydrogenase
• sepsis or DIC
• interventricular haemorrhage
• prematurity — due to immature liver

Question 37

What are the possible causes of intermediate jaundice?- (24 hours - 2 weeks)

Answer 37

• physiological
• breast milk
• sepsis
• haemolysis

Question 38

What are the possible causes of prolonged jaundice? (>2 weeks)

Answer 38

• extrahepatic obstruction (e.g. biliary atresia)
• neonatal hepatitis
• hypothyroidism
• breast milk