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#Phase 2.2: Paediatrics > Neonatal Jaundice > Flashcards

Neonatal Jaundice Flashcards

1
Q

What is neonatal jaundice?

A

Yellow skin + sclera

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2
Q

What is the basic cause of neonatal jaundice?

A

Bilirubin accum in skin + mucous membranes

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3
Q

How is bilirubin formed?

A

When Hb broken down into Unconjugated bilirubin

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4
Q

Where is bilirubin conjugated?

A

Liver

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5
Q

How is Conjugated bilirubin excreted? (2 things)

A
  1. Via Biliary system –> GI tract
  2. Via Urine
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6
Q

What % of infants get jaundice?

A

60% term infants

80% preterm infants

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7
Q

What are the types of hyperbilirubinaemia causes of neonatal jaundice? (2 things)

A
  1. Unconjugated (physiological / pathological)
  2. Conjugated (always pathological)
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8
Q

What are the causes of Physiological Jaundice? (2 things)

A
  1. High Foetal Hb concentration of neonate
  2. Immature liver
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9
Q

How does High Foetal Hb conc of neonate cause Physiological jaundice? (3 things)

A
  1. Neonate has high Foetal Hb conc (to maximise O2 exchange while it was in uterus)
  2. Foetal Hb = more fragile –> breaks down quickly
  3. Foetal Bilirubin usually excreted via Placenta –> No more placenta at birth = normal rise in Bilirubin levels
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10
Q

How does immature liver cause Physiological jaundice?

A

Less developed liver not able to conjugate high bilirubin concentrations yet

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11
Q

How do babies with Physiological jaundice present? (2 things)

A
  1. Mild yellowing of skin + sclera from day 2-7
  2. Baby otherwise healthy
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12
Q

When does Physiological jaundice usually completely resolve by?

A

Day 10

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13
Q

When is jaundice abnormal? (3 things)

A
  1. Starts within 24 hours of birth
  2. Lasts more than 14 days in full term baby
  3. Lasts more than 21 days in preterm baby
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14
Q

What are the 2 types of causes of Pathological Jaundice?

A
  1. Increased Bilirubin prod
  2. Decreased Bilirubin clearance
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15
Q

What are the causes of Increased Bilirubin production? (5 things)

A
  1. Haemolytic disease (rhesus / ABO incompatibility)
  2. Haemorrhage
  3. Polycthaemia
  4. Sepsis –> DIC
  5. G6PD deficiency
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16
Q

What are the causes of Decreased Bilirubin clearance? (6 things)

A
  1. Prematurity (immature liver obv)
  2. Breast milk jaundice
  3. Neonatal cholestasis
  4. Extrahepatic biliary atresia
  5. Endocrine disorders (hypothyriod / hypopituitary)
  6. Gilbert syndrome
17
Q

What are the CF of pathological jaundice? (8 things)

A
  1. Yellow skin / sclera
  2. Drowsy
  3. Not waking for feeds / short feeds
  4. Altered muscle tone / seizures (needs immediate attention)
  5. Abd mass / organomegaly
  6. Signs of infection
  7. Poor urine output
  8. Stool stays black / not changing colour
18
Q

What investigations should you do for neonatal jaundice? (7 things)

A
  1. FBC / Blood film
  2. LFT (Conjugated bilirubin levels)
  3. TFT
  4. Blood type testing
  5. Direct Coombs Test (aka direct antiglobulin test)
  6. Blood / urine cultures
  7. G6PD levels
19
Q

What are you suspecting if you do a FBC / blood film for neonatal jaundice? (2 things)

A
  1. Polycythaemia
  2. Anaemia
20
Q

What are you suspecting if you do a LFT (Conjugated bilirubin levels) for neonatal jaundice?

A

Hepatobiliary cause

21
Q

What are you suspecting if you do a TFT for neonatal jaundice?

A

Hypothyroid

22
Q

What are you suspecting if you do Blood type testing for neonatal jaundice? (2 things)

A
  1. ABO incompatibility
  2. Rhesus incompatibility
23
Q

What are you suspecting if you do a Direct Coombs Test for neonatal jaundice?

A

Haemolysis

24
Q

What are you suspecting if you do Blood / urine cultures for neonatal jaundice?

A

Infection (esp sepsis)

25
Q

What are you suspecting if you do G6PD levels for neonatal jaundice?

A

G6PD deficiency (aka me lol)

26
Q

When should you especially check G6PD levels in neonatal jaundice?

A

Mediterranean / African origin

27
Q

How is the treatment of neonatal jaundice decided?

A

Using a Treatment Threshold Chart

28
Q

How does a Treatment Threshold Chart work? (3 things)

A
  1. Babys age in days on X axis
  2. Total bilirubin no Y axis
  3. Depending on where baby’s value is, start that treatment
29
Q

What are the treatment options for neonatal jaundice? (2 things)

A
  1. Phototherapy (me lol)
  2. Exchange transfusion (rare, only for extremely high levels)
30
Q

What is phototherapy?

A

Expose baby to Blue light (while only wearing nappies and eye patches)

31
Q

How does phototherapy work to treat neonatal jaundice? (2 things)

A
  1. Breaks bilirubin down into Isomers
  2. Isomers can be excreted in bile / urine WITHOUT needing conjugation by liver
32
Q

What should you check after you complete phototherapy treatment and why? (2 things)

A
  1. Rebound bilirubin measure after 12-18 hours
  2. To make sure levels don’t rise above treatment threshold again
33
Q

What does Exchange Transfusion involve?

A

Removing blood from neonate –> replacing it with donor blood

34
Q

What is a complication of neonatal jaundice?

A

Kernicterus

35
Q

What is Kernicterus?

A

Bilirubin induced brain dysfunction

36
Q

How does Kernicterus happen?

A

High levels of bilirubin cross blood-brain barrier –> accum in CNS grey matter and damages CNS

37
Q

What are the CF of Kernicterus? (3 things)

A
  1. Less responsive
  2. Floppy n drowsy
  3. Poor feeding
38
Q

Is the damage to CNS in Kernicterus permanent?

A

Yes

39
Q

What can the damage to the CNS in Kernicterus lead to? (3 things)

A
  1. Cerebral palsy
  2. Learning disability
  3. Deafness

#Phase 2.2: Paediatrics (18 decks)

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