neonatal jaundice

Question 1

at what level does clinical jaundice become apparent ?

Answer 1

if the bilirubin exceeds 5 mg/dl in newborns

Question 2

when does physiological jaundice appear ?

Answer 2

after the 2nd day

Question 3

how long does neonatal physiological jaundice usually take to resolve ?

Answer 3

1. lasting till 8 days in term infants

2. up until 14 days in preterm infants

Question 4

when do we we say that the jaundice is prolonged ?

Answer 4

more than 2 weeks

Question 5

what process involving bilirubin happen in the liver ?

Answer 5

uptake conjugation and excretion

Question 6

what process are affected in the liver that cause a rise in unconjugated bilirubin ?

Answer 6

uptake

conjugation

Question 7

what syndromes cause pre hepatic jaundice ?

Answer 7

gilbert’s syndrome

Crigler Najjar Syndrome

Question 8

what type of bilirubin is increased in Gilberts syndrome ?

Answer 8

unconjugated bilirubin

Question 9

what is jaundice due to breast feeding ?

Answer 9

mother has scanty milk so the child is not stooling properly
which causes an increase in enterohepatic circulation

Question 10

what is breast milk jaundice ?

Answer 10

a diagnosis made by exclusion 
a late presentation of jaundice 
the child is gaining weight 
normally breast fed 
enzymes present in breast milk cause delayed excretion

Question 11

what is the most common cause of physiological jaundice ?

Answer 11

breakdown of Hb

followed by increase of the enterohepatic system

Question 12

which enzymes converts unconjugated bilirubin to conjugated bilirubin ?

Answer 12

UGT

which is low in activity before birth so takes some time to be activated

Question 13

what is the limit to the bilirubin levels in term and pre-term infants ?

Answer 13

term infants :
12 mg/dl 
preterm infants :
15 mg/dl
this is called phase 1

Question 14

when does the bilirubin level in infants return to the adult level and enter phase two ?

Answer 14

by the end of the first 2 weeks

Question 15

what are the most common causes of pathological jaundice in neonates ?

Answer 15

1. hemolysis :
either inherited diseases such as G6PD, Spherocytosis, pyruvate kinase deficiency
Blood group mismatch: Rh-ve or ABO 
extravasated blood : cephalohematoma 
polycythemia 
2. Sepsis

Question 16

how does sepsis cause jaundice ?

Answer 16

due to hypoalbuminemia

Question 17

if a baby present with jaundice at 3 weeks what is important to test for ?

Answer 17

thyroid function

Question 18

what are the methods of testing bilirubin levels ?

Answer 18

1. Transcutaneous bilirubinometer

2. invasively by taking a blood sample ( heel prick)

Question 19

when should a date for follow up givenn regarding jaundice according to the nomogram ?

Answer 19

low risk zone - in 3-5 days
low intermediate zone - repeat in 48 hours
high intermediate zone - repeat in 8-12 hours
high risk zone - stays in the hospital and is repeated in 4-8 hours

Question 20

why is leucocytic count important when investigating in prolonged jaundice ?

Answer 20

to check if there is sepsis causing the jaundice

Question 21

what kind of jaundice does sepsis cause ?

Answer 21

biphasic jaundice

Question 22

what increases the levels of conjugated bilirubin ?

Answer 22

anything that may cause compression to the CBD
like biliary atresia
biliary stones

Question 23

which type of bilirubin can pass through the blood brain barrier ?

Answer 23

unconjugated

Question 24

which part of the brain is affected by bilirubin ?

Answer 24

globus pallidus
basal ganglia
causes dyskinetic CP

Question 25

which mothers have a higher risk of jaundice in their newborns ?

Answer 25

blood group O mothers
( unless both parents are O)
RH negative mothers

Question 26

when is it indicated to perform a HIDA scan ?

Answer 26

when we have an increase in conjugated bilirubin to detect any bile duct obstruction

Question 27

what does the BIND score asses ?

Answer 27

mental state
muscle tone
high pitched cry
to asses bilirubin induced neurological dysfunction

Question 28

what results of the BIND score would indicate that intervention is necessary ?

Answer 28

> 4 moderate bilirubin encephalopathy
7 severe bilirubin encephalopathy
which means immediate exchange transfusion is necessary

Question 29

what are the methods of reducing bilirubin levels ?

Answer 29

phototherapy
or
exchange transfusion

Question 30

what are the two types of phototherapy ?

Answer 30

conventional phototherapy

intensive phototherapy

Question 31

what is the range of wavelength for phototherapy ?

Answer 31

between 430 and 490
also called blue light
wavelength below 400 should be avoided

Question 32

what precautions must be taken regarding phototherapy ?

Answer 32

1. cover eyes ( to avoid retinal damage )

2. cover genitalia ( DNA breakage )

Question 33

what type of blood is given in blood exchange transfusion ?

Answer 33

1. an AB child would be exchanged with O blood
2. double volume would be given
3. must be screened for all viruses and under aseptic conditions

Question 34

what is the treatment in cases of isoimmune hemolysis ?

Answer 34

high dose immunoglobulin

Question 35

what type of drugs cause hemolysis in G6PD ?

Answer 35

sulphinamides

Question 36

what time period do we say that the jaundice is pathological ?

Answer 36

first 24 hours or life

or after 14 days

Question 37

what are the prognostic factors of ABE ?

Answer 37

acute bilirubin encephalopathy:

1. core hypertonia
2. opisthotonus