neonatal jaundice

Question 1

what is it

Answer 1

build up of bilirubin

Question 2

pathological jaundice and causes

Answer 2

within first 24h

severe heamolysis
causes of this are
ABO incompatibility
Rh immunisation
Sepsis

if >15% of tot`l conjugated bilirubin increased then hepatitis

Question 3

causes 24h- 14 days

Answer 3

Physiologic jaundice
Breast milk jaundice
Dehydration
Infection, including sepsis
Haemolysis
Bruising
Polycythaemia
Crigler-Najjar Syndrome

Question 4

phycological jaundice causes

Answer 4

polycythaemic - high RBC
Red cell life span of newborns is shorter than adults
Hepatic bilirubin metabolism less efficient in first few days of life

Question 5

complications

Answer 5

Kernicterus- damage to basal ganglia in brain
cerebral palsy

Question 6

investigations of pathological jaundice

Answer 6

Total bilirubin concentration (SBR)

Maternal blood group and antibody titres (if Rh negative)

Baby’s blood group, Direct Agglutination Test (detects antibodies on the baby’s red cells), and elution test to detect anti-A or anti-B antibodies on baby’s red cells
Full blood count, looking for Hb level, evidence of haemolysis, unusually-shaped red cells, or evidence of infection

Glucose 6 Phosphate Dehydrogenase deficiency

Question 7

pathological jaundice 24h-10 days

Answer 7

high unconjugated bilirubin causes bilirubin encephalopathy

features - hypotonia, arching of head, neck and back, spasticity, seizures

Question 8

pathological jaundice 24h-10 days causes

Answer 8

Mild dehydration/insufficient milk supply
Breakdown of extravasated blood e.g. cephalohaematoma, bruising

Haemolysis -
Infection
Increased enterohepatic circulation (e.g. gut obstruction)

Question 8

pathological jaundice 24h-10 days causes

Answer 8

Mild dehydration/insufficient milk supply
Breakdown of extravasated blood e.g. cephalohaematoma, bruising

Haemolysis -
Infection
Increased enterohepatic circulation (e.g. gut obstruction)

Question 9

Pathological Jaundice“Too Long” >14 days term or 21 days preterm

Answer 9

persistent unconjugated high bilirubin causes
Breast milk jaundice
(diagnosis of exclusion, cessation of breast feeding is not advised)

Poor milk intake
Haemolysis
Infection (especially urinary tract infection)
Hypothyroidism

if high conjugated then always abnormal!!
causes- hepatitis, biliary atresia

Question 10

treatment

Answer 10

phototherapy- UV light 460-490nm

exchange transfusion of RBC

IV immunoglobulin