neonatal jaundice Flashcards
a 2 day old baby develops jaundice and then parents think it began 12 hour after birth - what investigation is the most helpful ?
direct Coombs test
jaundice developing before 24 hours is always pathological
Coombs test for Rhesus haemolytic disease and ABO incompatibility
causes for jaundice that developed <24 hours
haemolytic disease
congenital infection (TORCH indicated)
sepsis
causes for jaundice developed from 24 hours - 14 days
physiological
breast milk jaundice
dehydration
infection
haemolysis
bruising
polycythaemia
causes for jaundice developed > 14 days / > 21 days for preterm
physiologic jaundice
breast milk
infection
hypothyroidism
biliary obstruction
neonatal hepatitis
what causes physiologic jaundice
there is elevated bilirubin due to:
babies being relatively polycythaemic at birth
red cell life span is shorter than in adults
delayed passage of meconium
hepatic bilirubin metabolism less efficient in first few days of life
management of neonatal jaundice
bilirubin levels should be measured and plotted on the nomograms
-PHOTOTHERAPY OR EXCHANGE TRANSFUSION
look at the clinical history
what is kernicterus
serious complication of untreated jaundice in babies > excess bilirubin damaging the brain especially the basal ganglia
A 5 hour old neonate born at 36 weeks gestation is found to have significant hyperbilirubinaemia during assessment is noted to have increased lethargy and be hypotonic on examination. The medical team is concerned that the infant has developed an acute bilirubin encephalopathy.
Which of the following statements is correct regarding acute bilirubin encephalopathy (ABE)?
toxic build-up of unconjugated bilirubin
A 5 hour old neonate born at 36 weeks gestation is found to have significant hyperbilirubinaemia during assessment is noted to have increased lethargy and be hypotonic on examination. The medical team is concerned that the infant has developed an acute bilirubin encephalopathy.
Which of the following statements is correct regarding acute bilirubin encephalopathy (ABE)?
toxic build-up of unconjugated bilirubin
A mother attends the emergency department with a 26-day old boy. The boy is breastfed, but shows poor weight gain. He is jaundiced and lethargic, and is passing dark urine and pale stool. What is the most likely diagnosis?
biliary atresia
A 27 day old neonate is brought in to Accident and Emergency by his mother as she noticed that he is not feeding well. The baby is exclusively breast fed and has not had any problems with latching on before. The baby was last weighed a few days ago, and has been putting on weight.
On examination, the baby looks jaundiced and is lethargic. The stool is of a normal colour and consistency. The mother says that there have been fewer wet nappies over the last 12 hours. There is some loss of skin turgor. There is no hepatomegaly on palpation of the abdomen.
What is your most appropriate management?
full septic screen
how is biliary atresia diagnosed
cholangiography
what is routinely tested for in physiological jaundice
unconjugated bilirubin
what is Rhesus disease
a condition caused by anti-rhesus antibodies created in the mother and transferred via the placenta to the foetus, which can in turn lead to haemolysis, severe hyperbilirubinaemia and anaemia
most commonly it is caused by anti - rhesus D Ig G antibodies
what investigations do you carry out for early presenting jaundice
FBC
SBR
DCT
and investigate underlying cause
