NEONATAL JAUNDICE Flashcards
Jaundice is visible in neonates at what serum bilirubin level
100mcmol/L
……….. refers to bilirubin encephalopathy
Kernicterus
Consequences of kernicterus
Death
Cerebral palsy
Deafness
Mental retardation
Motor incoordination
Physiological jaundice occurs on day………. and lasts up to day……..
3 , 10
Jaundice is like to be pathological in neonates if………..
- Present within first day of life
or - Conjugaetd bilirubin is>40mcmol/L
or - Total bilirubn > 170mcmol/L in preterm or >260mcmol/L in term infants
or - Neonate is significantly jaundiced beyond 14 days
or - Jaundice occurs with fever
Definitive treatment for hyperbilirubinemia that has reached kernicterus
Exchange transfusion
Causes of neonatal jaundice
Physiological
Hemolysis
Blood extravasation
Sepsis
Congenital infections
Liver disease
Metabolic disorders
Enhance extra-hepatic circulation
Congenital defects of bilirubin metabolism
Breast milk related jaundice
Metabolic disorders that can cause neonatal jaundice
Galactosemia
Hypothyroidism
Factors that can enhance extra hepatic circulation in infants
GIT obstruction
Inadequate feeding
Factors that can cause neonatal jaundice through blood extravasation
Cephalhaematoma
Subgaleal hematoma
Factors that can cause hemolysis related neonatal jaundice
Rhesus
ABO incompatibility
G6PD deficiency
Symptoms of neonatal jaundice
Yellow eyes
Yellow skin, hands and feet
Pale stools
Signs of neonatal jaundice
Jaundice
Yellow pigment in skin
Yellow palms +/- yellow soles of feet
Pale stools
Pale stools in neonatal jaundice indicates that biliary atresia is unlikely
False
Investigations in neonatal jaundice
Total and direct serum bilirubin concentration
Other tests based on age, presentation and suspected cause
Investigations to be done in Early onset jaundice (within first 24 hours of birth)
Blood group and rhesus (Rh) group of both infant and mother
Direct Coombs test, Indirect Coombs test, FBC, G6PD
Blood film for red cell anomalies, malaria parasites
Cultures of blood, urine, and spinal fluid may be indicated
Investigations to be done in Prolonged jaundice (after 14 days)
Liver Function tests
Thyroid Function tests
Urine for reducing substances
Urine R/E and C/S
TORCH (congenital infections) screen
Hep B
Abdominal ultrasound scan (exclude biliary atresia)
Treatment objectives in neonatal jaundice
To prevent kernicterus
To treat underlying cause
Non-pharmacological interventions in neonatal jaundice
Phototherapy
Exchange blood transfusion
Phototherapy is started if:
- Jaundice is visible on day 1
- Jaundice involves palms and soles of feet
- Jaundice in prematurity
- After day 2, unconjugated bilirubin> 170 micromol/L in preterm or > 260 micromol/L in term neonate
How long is phototherpay done
Phototherapy should be continued till unconjugated bilirubin levels remain < 170 micromol/L in preterm or < 260 micromol/L in term neonate for at least 24 hours.
What is phototherapy
Phototherapy refers to the use of light to convert bilirubin molecules in the body into water soluble isomers that can be excreted by the body
Colour of tube used for phototherapy and the preferred colour
Blue fluorescent tube- preferred
White fluorescent tube light
Which wavelength of light is most effective for phototherapy
Blue-green light in the range of 460-490nm
Mechanism of phototherapy
Absorption of light converts normal bilirubin (4Z,15Z-bilirubin) into
1. Configurational isomers (4Z, 15E-biilirubin)- bile
2. Structural isomers (Z-lumirubin)- urine, bile
3. Photooxidation products- urine
These products are less lipophilic than bilirubin and can be excreted through urine or bile without underoing glucuronidation by the liver
Volume and duration of exchange blood transfusion
160ml/kg over 2 to 3 hours
Monitoring parameters during exchange transfusion
Heart rate
Respiratory rate
Bilirubin
Blood glucose
Stop exchange blood transfusion when heart rate fluctuates by
More than 20beats/minutes
Exchange transfusion or phototherapy can be considered in these patients even if unconjugated bilirubin levels are < 170 micromol/L in preterm or < 260 micromol/L
Sick or low birth weight
Following asphyxia
Prolonged hyoxemia
Acidosis
Sepsis
Hydrops foetalis
Hydrops fetalis is a condition in the fetus characterized by the abnormal interstitial fluid collection in 2 or more compartments of the fetal body (peritoneal cavity, pleura, and pericardium)
When is exchange transfusion necessary
- Serum bilirubin >340 mcmol/L in term infant more than 2 kg
- In newborns weighing less than 2 kg, serum bilirubin exceeding the following
would require exchange transfusion
1 kg - 170 micromol/L
1-2 kg - 250 micromol/L
Cord Hb < 12 g/dL or cord bilirubin > 80 micromol/L
Rapid progression of anaemia in presence of resolving jaundice
Hydrops foetalis
Treatment for hydrops foetalis in a jaundiced neonate
Immediate exchange transfusion with packed cells
