Neonatal Jaundice Flashcards
What is jaundice?
The condition of abnormally high levels of bilirubin in the blood.
What are the causes of neonatal jaundice divided into?
Increased production and decreased clearance
What are causes of increased production of bilirubin?
- Haemolytic disease of the newborn
- ABO incompatibility
- Haemorrhage
- Intraventricular haemorrhage
- Cephalo-haematoma
- Polycythaemia
- Sepsis and disseminated intravascular coagulation
- G6PD deficiency
What are the causes of decreased clearance of bilirubin?
- Prematurity
- Breast milk jaundice
- Neonatal cholestasis
- Extrahepatic biliary atresia
- Endocrine disorders (hypothyroid and hypopituitary)
- Gilbert syndrome
What happens in premature babies due to an immature liver?
The process of jaundice is exaggerated
What is there an increased risk of in premature babies due to the immature liver?
Kernicterus
What is kernicterus?
Brain damage due to high bilirubin levels.
Which babies are more likely to have jaundice?
Breast fed babies
What are the potential reasons why breast fed babies are more likely to experience jaundice?
- 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.
What do components of breast milk have the ability to do?
Inhibit the ability of the liver to process the bilirubin.
What can inadequate breastfeeding lead to?
Slow passage of stools, increasing absorption of bilirubin in the intestines.
What is the cause of jaundice in the first 24 hours?
Pathological
What are the possible causes of jaundice in the first 24 hours?
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase
What might babies with jaundice need in the first 24 hours?
Treatment for sepsis if they have any other clinical features or risk factors.
When is jaundice common in a neonate?
Jaundice in the neonate from 2-14 days
What is usually the cause of jaundice in the neonate from day 10-14?
Physiological
What factors contribute to jaundice in the neonate from day 10-14?
- more red blood cells
- more fragile red blood cells
- less developed liver function.
Who is jaundice at day 10-14 commonly seen in?
Breast fed babies
What is Jaundice after 14 days in a neonate called?
Prolonged jaundice
What is preformed if there is still jaundice after 14 days?
Prolonged jaundice screen
What investigations might you carry out in a neonate with prolonged jaundice?
- 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
What are possible causes of prolonged jaundice?
- biliary atresia
- hypothyroidism
- G6PD deficiency
- galactosaemia
What are the other possible causes of prolonged jaundice?
Breastfed babies
Prematurity
Congenital infection
Which congenital infections can cause neonatal jaundice?
CMV
Toxoplasmosis
How can prematurity increase the risk of prolonged jaundice?
Immature liver
Increased risk of kernicterus
What is the management of a child with neonatal jaundice?
Phototherapy is usually adequate to correct neonatal jaundice.
What might extremely high levels of bilirubin indicate?
Extremely high levels of may require an exchange transfusion- removing blood from the neonate and replacing it with donor blood.
What is the function of phototherapy?
Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver
What is the function of phototherapy?
Converts unconjugated bilirubin into isomers that can be excreted in the bile and urine without requiring conjugation in the liver
When does physiological jaundice tend to occur?
Day 2-7
When does physiological jaundice tend to resolve?
Day 10
How can a child with physiological jaundice present?
Yellowing of skin and sclera
What is physiological jaundice due to?
Fetal red blood cells break down more rapidly than normal red blood cells, releasing lots of bilirubin
When can breast milk jaundice occur?
24 hours to 2 weeks after birth
When is jaundice classified as abnormal?
- 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
What are the possible causes of early jaundice? (Less than 24 hours )
- rhesus haemolytic disease
- ABO haemolytic disease
- hereditary spherocytosis
- glucose-6-phosphodehydrogenase
- sepsis or DIC
- interventricular haemorrhage
- prematurity — due to immature liver
What are the possible causes of intermediate jaundice?- (24 hours - 2 weeks)
- physiological
- breast milk
- sepsis
- haemolysis
What are the possible causes of prolonged jaundice? (>2 weeks)
- extrahepatic obstruction (e.g. biliary atresia)
- neonatal hepatitis
- hypothyroidism
- breast milk
