Neonatal jaundice

Question 1

What causes jaundice?

Answer 1

RBC breakdown -> unconjugated bilirubin

Question 2

Why do neonates get physiological jaundice?

Answer 2

High conc of frgaile RBC in foetus
Less developed liver function

Question 3

How long does physiological neonatal jaundice last?

Answer 3

2-7 dyas
Completely resolves by 10 dyas

Question 4

Causes of neonatal jaundice - increased production

Answer 4

Haemolytic disease of newborn
ABO incompatability
Haemorrhage
Intraventricular haemorrhage
Cephalo-haematoma
Polycythaemia
Sepsis and DIC
G6PD deficiency

Question 5

Causes of neonatal jaundice in neonate - decreased clearnace

Answer 5

Prematurity
Breast milk jaundice
Neonatal cholestasus
Extrahepatic biliary atresia
Endocrine disorders - hypothyoroid, hypopituatitary
Gilbery dyndrome

Question 6

When is neonatal jaundice pathologucal

Answer 6

first 24 hours of life
Urgent investigations and management - sepsis is common cause

Question 7

Why is jaundice ecaggerated in prematuriyy

Answer 7

Immature liver

Question 8

What does jaundice in premature babies cause

Answer 8

Kernicterus - brain damage due to high bilirubin levels

Question 9

Why ccan breast milk lead to jaundice

Answer 9

Components inhibit liver process bilirubin
Dehydration more likely w inadequate feeds
-> slow passage stools, inreasing absorption of bilirubin in intestines

Question 10

What is prolonged jaundice

Answer 10

> 14 days in full term babies
21 days in premature babies

Question 11

Causes of prolonged jaunduce

Answer 11

Biliray atresia
Hypothyroidism
G6PD deficiency

Question 12

Investigations for neonatal jaundice

Answer 12

FBC + blood film - polycythaemia/anaemia
Conjugated bilirubin
Blood type test - ABO/rhesus
Direct Coombs tetst - haemolysis
Thyrodi function
Blood and urine culutres
G6PD levels

Question 13

What does eleveated conjugated bilirubin suggest about cause?

Answer 13

Hepatobiliary

Question 14

Mangament of jaundice in neonates

Answer 14

Chart plot - age and total bilirubin
Familiarise with treatment threshold
Phototherapy
Exchange transfusion if severe

Question 15

What does phototherapy do?

Answer 15

Converts uncojugated bilirubin into isomers that can be excreted in bile and urine without requiring conjugation in the liver
Light box used on babies skin
Double = two light boxes
Bilirubin monitored closely
Rebound bilirubin measured 12-18 hours after phototherapy complete

Question 16

Why can bilirubin affect the brain

Answer 16

Can cross BBB

Question 17

How does kernicterus present

Answer 17

Floppy
Less responsive drowsy bay with poor feeding

Question 18

What does kernicterus cayse?

Answer 18

Permanent brain damage - CP, LD, deafness, extrapyramidal sy,ptoms

Question 19

Causes of day 1 jaundice

Answer 19

Haemolytic disease of the newborn
Hereditary spherocytosis
Sepsis

Question 20

Day 7 onwards new jaundice neonate

Answer 20

Biliray atresua - progressive destruction of buluary tree

Question 21

Treatment biliary atresia

Answer 21

Before 6 weeks - kasi procedure
Othewise need liver transplant
Born without ducts - bule gets backed up into liver -> hepatits, cirrhosis, liver failure

Question 22

What is kasis procedure

Answer 22

Connect duodenum to bladder

Question 23

What bilirubin can cross the BBB and when

Answer 23

< 8 weeks BB is immature -> unconjugated bilirubin -> encephalopathy
Conjugated cant cross