neonatal jaundice Flashcards
at what level does clinical jaundice become apparent ?
if the bilirubin exceeds 5 mg/dl in newborns
when does physiological jaundice appear ?
after the 2nd day
how long does neonatal physiological jaundice usually take to resolve ?
- lasting till 8 days in term infants
2. up until 14 days in preterm infants
when do we we say that the jaundice is prolonged ?
more than 2 weeks
what process involving bilirubin happen in the liver ?
uptake conjugation and excretion
what process are affected in the liver that cause a rise in unconjugated bilirubin ?
uptake
conjugation
what syndromes cause pre hepatic jaundice ?
gilbert’s syndrome
Crigler Najjar Syndrome
what type of bilirubin is increased in Gilberts syndrome ?
unconjugated bilirubin
what is jaundice due to breast feeding ?
mother has scanty milk so the child is not stooling properly
which causes an increase in enterohepatic circulation
what is breast milk jaundice ?
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
what is the most common cause of physiological jaundice ?
breakdown of Hb
followed by increase of the enterohepatic system
which enzymes converts unconjugated bilirubin to conjugated bilirubin ?
UGT
which is low in activity before birth so takes some time to be activated
what is the limit to the bilirubin levels in term and pre-term infants ?
term infants : 12 mg/dl preterm infants : 15 mg/dl this is called phase 1
when does the bilirubin level in infants return to the adult level and enter phase two ?
by the end of the first 2 weeks
what are the most common causes of pathological jaundice in neonates ?
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
how does sepsis cause jaundice ?
due to hypoalbuminemia
if a baby present with jaundice at 3 weeks what is important to test for ?
thyroid function
what are the methods of testing bilirubin levels ?
- Transcutaneous bilirubinometer
2. invasively by taking a blood sample ( heel prick)
when should a date for follow up givenn regarding jaundice according to the nomogram ?
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
why is leucocytic count important when investigating in prolonged jaundice ?
to check if there is sepsis causing the jaundice
what kind of jaundice does sepsis cause ?
biphasic jaundice
what increases the levels of conjugated bilirubin ?
anything that may cause compression to the CBD
like biliary atresia
biliary stones
which type of bilirubin can pass through the blood brain barrier ?
unconjugated
which part of the brain is affected by bilirubin ?
globus pallidus
basal ganglia
causes dyskinetic CP
