Neonatal Jaundice Flashcards
Analyze the different treatment options for neonatal jaundice, focusing on the use of phototherapy and exchange blood transfusions in severe cases.
Phototherapy is the primary treatment for neonatal jaundice. It reduces the levels of bilirubin in the blood and prevent brain damage caused by bilirubin toxicity. In rare case where jaundice is not responding to phototherapy exchange blood transfusion are used to reduce the bilirubin level. Although phototherapy is considered safe, some research studies have raised concerns about its potential DNA damage to animals and cells culture. Other research finds out infant who undergo phototherapy have increased levels of oxidative stress marker, higher risk to develop childhood cancer and are at a greater risk of breastfeeding failure.
Describe the role of midwives in providing follow-up care for infants with jaundice in the community, including the importance of early detection and appropriate therapy.
Midwives should create a feeding plan and recommend parents to increase the number of feedings per day and refers to lactation specialists. Jaundice examination should be performed in a natural light environment d head to toes checks, ask parents questions about feeding choice, frequency of feeding, numbers of nappies urine / stools, observe breastfeeding, escalate any concerns to the team and document the findings. Early discharge is the leading cause of hospital readmission and makes it difficult to identify jaundice, midwives should make sure breastfeeding support is established before discharge. It is important to diagnose jaundice at early stage as delayed can increased bilirubin levels and lead to poorer outcomes in readmission.
Explore the potential risks and controversies surrounding phototherapy as a treatment for neonatal jaundice, including concerns about DNA damage and increased oxidative stress markers.
some research studies have raised concerns about its potential DNA damage to animals and cells culture. Other research finds out infant who undergo phototherapy have increased levels of oxidative stress marker, higher risk to develop childhood cancer and are at a greater risk of breastfeeding failure.
Explain the potential risks associated with untreated neonatal jaundice, including acute bilirubin encephalopathy and kernicterus.
kernicterus can happen when bilirubin stains the deep part of the brain (basal ganglia) and cause brain damage, the correct amount of bilirubin that is harmful to the brain it is unknown. Recent studies suggests that kernicterus is becoming common in countries where it was rare due to early hospital discharge.
Discuss the difference between physiological jaundice and pathological jaundice in newborns, including their causes and treatment options.
Pathophysiology
In the utero bilirubin normally expelled via placenta, however after birth fetus no longer have access to placenta excretion, newborn have higher bilirubin concentration due to elevated number of red blood cell which have shorter lifespan. Red blood cells degradation generates unconjugated bilirubin binds to albumin and circulates until the liver metabolises it into conjugated bilirubin and eliminates in the stools
Jaundice presentation
Neonatal jaundice is present in yellowing of the skin and eyes due to higher bilirubin level, a condition in which the bilirubin accumulated in the skin and mucus membranes. Around 50% of term and 80% preterm infants will develop jaundice in the first week of life with 10% requiring treatment, jaundice is a condition that needs medical attention.
Physiology vs pathological jaundice
Physiological jaundice is a normal reaction to liver immaturity, it usually appears in day 2 and 3 and goes away within 1-2 weeks without requiring any treatment. Pathological jaundice appears within the 24h of birth due to the underlying medical condition such as ABO incompatibility, haemolysis, sepsis, G6PD, metabolic disorders.
Breastfeeding jaundice vs
Breastfeeding babies are at higher risk of developing jaundice that formula babies, this is due to babies not getting adequate breastmilk may leads to slow passage of stools and increased bilirubin absorption in the intestine on contrary breastmilk jaundice causes is still unknown many doctors believes is due to certain enzyme in the milk that slow down the breakdown of bilirubin in the liver
Breastmilk jaundice
Breast milk jaundice syndrome is also observed in breastfed infants, where unconjugated jaundice persists for longer than two weeks. However, parents are encouraged to continue with breastfeeding. As the benefits outweigh the risks, midwives should provide parents with adequate support.
The role of the midwife in the multidisciplinary team in relation to care of neonates with neonatal jaundice.
Midwives should create a feeding plan and recommend parents to increase the number of feedings per day and refers to lactation specialists. Jaundice examination should be performed in a natural light environment d head to toes checks, ask parents questions about feeding choice, frequency of feeding, numbers of nappies urine / stools, observe breastfeeding, escalate any concerns to the team and document the findings.
What is early discharge implication
Early discharge is the leading cause of hospital readmission and makes it difficult to identify jaundice, midwives should make sure breastfeeding support is established before discharge. It is important to diagnose jaundice at early stage as delayed can increased bilirubin levels and lead to poorer outcomes in readmission.
What is visual discharge disadvantages?
Visual inspection of jaundice can be inaccurate especially with dark skin tone and Asian background babies. It is also important to educate parents on the signs and symptom to look out such as, poor feeding, yellow skin, lethargic and dark urine and where to report any changes. Midwives should provide effective community follow up and be aware of other risk factors and underlying medical conditions and variation from the norm to implement appropriate care and referral .
Jaundice device and treatment options
They are device available to measure TSB, TCB are used for screening. Another diagnose can be done by taking blood samples to measure TSB.
Treatment is decided based on the level of TSB and the presence of other risk factors that could worsen the condition such as preterm. It recommended to start enteral feeding in preterm infants to promotes intestinal motility and the formation of gut flora for the elimination of bilirubin.
Jaundice investigation
Investigation includes blood test for mother and baby (ABO incompatibility), direct coombs test and full blood count.
Indirect risk factors
Risk factors
• Prematurity
• Breast milk jaundice
• Neonatal cholestasis
• Extrahepatic biliary atresia
• Endocrine disorders (hypothyroid and hypopituitary)
• Gilbert syndrome
