Neonatal jaundice

Question 1

Neonatal jaundice

Answer 1

Always pathological in first 24 hours

Question 2

Haemolytic disease of the newborn pathophysiology

Answer 2

Rhesus positive cells from fetus pass into circulation of rhesus negative mother
=> Primary immune response and antibody production
=> In subsequent pregnancies, large amount of maternal anti-D Ab made
=> Cross placenta, affix to fetal red blood cells
=> Fetus recognises as foreign and cell is haemolysed
=> Anaemia, hyperbilirubinaemia, excessive erythroid tissue production in liver, spleen, bone marrow, skin and placenta

Question 3

Haemolytic disease of the newborn clinical features

Answer 3

Antenatally, Coombs test
Jaundice in first 24 hours
Pallor, hepatosplenomegaly
Hypoglycaemia
Fetal hydrops

Question 4

Haemolytic disease of the newborn management

Answer 4

anti-D immunoglobulin to mother after birth of Rh-positive child or potentially sensitising event (ante-partum haemorrhage)
Transfusion and phototherapy

Question 5

Physiological jaundice

Answer 5

Increased erythrocyte breakdown and immature liver function
Presents at 2-3 days, begins to disappear end of first week, resolved by day 10
Bilirubin does not exclude 200micromol/L and baby well
Bilirubin may go much higher if baby preterm or increased red cell breakdown

Question 6

Breastmilk jaundice

Answer 6

> 2 weeks
Due to unconjugated hyperbilirubinaemia
15% healthy breast fed babies
Baby well, resolves within 6 weeks