Neonatal Jaundice Flashcards
What is neonatal jaundice?
Yellow skin + sclera
What is the basic cause of neonatal jaundice?
Bilirubin accum in skin + mucous membranes
How is bilirubin formed?
When Hb broken down into Unconjugated bilirubin
Where is bilirubin conjugated?
Liver
How is Conjugated bilirubin excreted? (2 things)
- Via Biliary system –> GI tract
- Via Urine
What % of infants get jaundice?
60% term infants
80% preterm infants
What are the types of hyperbilirubinaemia causes of neonatal jaundice? (2 things)
- Unconjugated (physiological / pathological)
- Conjugated (always pathological)
What are the causes of Physiological Jaundice? (2 things)
- High Foetal Hb concentration of neonate
- Immature liver
How does High Foetal Hb conc of neonate cause Physiological jaundice? (3 things)
- Neonate has high Foetal Hb conc (to maximise O2 exchange while it was in uterus)
- Foetal Hb = more fragile –> breaks down quickly
- Foetal Bilirubin usually excreted via Placenta –> No more placenta at birth = normal rise in Bilirubin levels
How does immature liver cause Physiological jaundice?
Less developed liver not able to conjugate high bilirubin concentrations yet
How do babies with Physiological jaundice present? (2 things)
- Mild yellowing of skin + sclera from day 2-7
- Baby otherwise healthy
When does Physiological jaundice usually completely resolve by?
Day 10
When is jaundice abnormal? (3 things)
- Starts within 24 hours of birth
- Lasts more than 14 days in full term baby
- Lasts more than 21 days in preterm baby
What are the 2 types of causes of Pathological Jaundice?
- Increased Bilirubin prod
- Decreased Bilirubin clearance
What are the causes of Increased Bilirubin production? (5 things)
- Haemolytic disease (rhesus / ABO incompatibility)
- Haemorrhage
- Polycthaemia
- Sepsis –> DIC
- G6PD deficiency
What are the causes of Decreased Bilirubin clearance? (6 things)
- Prematurity (immature liver obv)
- Breast milk jaundice
- Neonatal cholestasis
- Extrahepatic biliary atresia
- Endocrine disorders (hypothyriod / hypopituitary)
- Gilbert syndrome
What are the CF of pathological jaundice? (8 things)
- Yellow skin / sclera
- Drowsy
- Not waking for feeds / short feeds
- Altered muscle tone / seizures (needs immediate attention)
- Abd mass / organomegaly
- Signs of infection
- Poor urine output
- Stool stays black / not changing colour
What investigations should you do for neonatal jaundice? (7 things)
- FBC / Blood film
- LFT (Conjugated bilirubin levels)
- TFT
- Blood type testing
- Direct Coombs Test (aka direct antiglobulin test)
- Blood / urine cultures
- G6PD levels
What are you suspecting if you do a FBC / blood film for neonatal jaundice? (2 things)
- Polycythaemia
- Anaemia
What are you suspecting if you do a LFT (Conjugated bilirubin levels) for neonatal jaundice?
Hepatobiliary cause
What are you suspecting if you do a TFT for neonatal jaundice?
Hypothyroid
What are you suspecting if you do Blood type testing for neonatal jaundice? (2 things)
- ABO incompatibility
- Rhesus incompatibility
What are you suspecting if you do a Direct Coombs Test for neonatal jaundice?
Haemolysis
What are you suspecting if you do Blood / urine cultures for neonatal jaundice?
Infection (esp sepsis)
