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STG 2017 > NEONATAL JAUNDICE > Flashcards

NEONATAL JAUNDICE Flashcards

1
Q

Jaundice is visible in neonates at what serum bilirubin level

A

100mcmol/L

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2
Q

……….. refers to bilirubin encephalopathy

A

Kernicterus

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3
Q

Consequences of kernicterus

A

Death
Cerebral palsy
Deafness
Mental retardation
Motor incoordination

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4
Q

Physiological jaundice occurs on day………. and lasts up to day……..

A

3 , 10

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5
Q

Jaundice is like to be pathological in neonates if………..

A
  1. Present within first day of life
    or
  2. Conjugaetd bilirubin is>40mcmol/L
    or
  3. Total bilirubn > 170mcmol/L in preterm or >260mcmol/L in term infants
    or
  4. Neonate is significantly jaundiced beyond 14 days
    or
  5. Jaundice occurs with fever
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6
Q

Definitive treatment for hyperbilirubinemia that has reached kernicterus

A

Exchange transfusion

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7
Q

Causes of neonatal jaundice

A

Physiological
Hemolysis
Blood extravasation
Sepsis
Congenital infections
Liver disease
Metabolic disorders
Enhance extra-hepatic circulation
Congenital defects of bilirubin metabolism
Breast milk related jaundice

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8
Q

Metabolic disorders that can cause neonatal jaundice

A

Galactosemia
Hypothyroidism

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9
Q

Factors that can enhance extra hepatic circulation in infants

A

GIT obstruction
Inadequate feeding

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10
Q

Factors that can cause neonatal jaundice through blood extravasation

A

Cephalhaematoma
Subgaleal hematoma

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11
Q

Factors that can cause hemolysis related neonatal jaundice

A

Rhesus
ABO incompatibility
G6PD deficiency

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12
Q

Symptoms of neonatal jaundice

A

Yellow eyes
Yellow skin, hands and feet
Pale stools

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13
Q

Signs of neonatal jaundice

A

Jaundice
Yellow pigment in skin
Yellow palms +/- yellow soles of feet
Pale stools

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14
Q

Pale stools in neonatal jaundice indicates that biliary atresia is unlikely

A

False

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15
Q

Investigations in neonatal jaundice

A

Total and direct serum bilirubin concentration
Other tests based on age, presentation and suspected cause

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16
Q

Investigations to be done in Early onset jaundice (within first 24 hours of birth)

A

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

17
Q

Investigations to be done in Prolonged jaundice (after 14 days)

A

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)

18
Q

Treatment objectives in neonatal jaundice

A

To prevent kernicterus
To treat underlying cause

19
Q

Non-pharmacological interventions in neonatal jaundice

A

Phototherapy
Exchange blood transfusion

20
Q

Phototherapy is started if:

A
  1. Jaundice is visible on day 1
  2. Jaundice involves palms and soles of feet
  3. Jaundice in prematurity
  4. After day 2, unconjugated bilirubin> 170 micromol/L in preterm or > 260 micromol/L in term neonate
21
Q

How long is phototherpay done

A

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.

22
Q

What is phototherapy

A

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

23
Q

Colour of tube used for phototherapy and the preferred colour

A

Blue fluorescent tube- preferred
White fluorescent tube light

23
Q

Which wavelength of light is most effective for phototherapy

A

Blue-green light in the range of 460-490nm

23
Q

Mechanism of phototherapy

A

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

24
Q

Volume and duration of exchange blood transfusion

A

160ml/kg over 2 to 3 hours

25
Q

Monitoring parameters during exchange transfusion

A

Heart rate
Respiratory rate
Bilirubin
Blood glucose

26
Q

Stop exchange blood transfusion when heart rate fluctuates by

A

More than 20beats/minutes

27
Q

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

A

Sick or low birth weight
Following asphyxia
Prolonged hyoxemia
Acidosis
Sepsis

28
Q

Hydrops foetalis

A

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)

28
Q

When is exchange transfusion necessary

A
  1. Serum bilirubin >340 mcmol/L in term infant more than 2 kg
  2. 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
29
Q

Treatment for hydrops foetalis in a jaundiced neonate

A

Immediate exchange transfusion with packed cells

STG 2017 (88 decks)

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