Neonatal Jaundice Flashcards
What is kernicterus?
A histology cal finding if uncongugated bili getting deposited in basal ganglia and brainstem nuclei.
Un conjugated bili>exceeds bili binding capacity of albumin>crosses bbb as it fat soluble>deposit in basal ganglia and cr nerve nuclei> encephalopathy
Why NJ is important
- Another disorder
2. kernicterus
Clinically jaundice visible at what level if bili?
80-120 micrmls/l
When do u say its conjugated bilirubinimea
When conjugated bili is >20% of total or
>2mg/dl
Divide jaundice according or age of onset
3weeks
Causes for NJ <24 hrs
Haemolitic anaemia ABO incomp Rh incomp G6PD def Pryuvate kinase def Spherocytosis Eleptocytosis
Cong infections
Causes for 24hrs to 3 weeks
In 1st week- Physiol J Breast feeding J Infections-UTI Haemoly Anaemia Polycythemia Bruising Crigler najjar syn
After 1st week- Phy B milk j Infections Non immune ahem anaemia Hepatitis B atresia hypothyroid
Causes for J >3 weeks
Conjugated- N hepatitis Biliary atresia Choledochal cyst Paucity if bile ducts Cystic f Insipissted bil sy Conge infection Galactosemai
Uncongu- BM j Phys J Infections Hypothyroidism Haemolitic an Downs
Rh incompatibility pathophysiology
Rh -v mom has Rh +v baby> fetal blood goes to mom>mom produce anti Rh AB>IgM crossing the placenta is less >1st baby less affected
IgG later crosses affect next baby if Rh pos>severe anaemia >HF with increase hydrostatic pressure and liver failure by extram hematopoietic and low protein with increase cap permiabilt >fluid in cavities
liver and spleen erythroposis>hepatospleenagaly>hydrops fetal us and death
ABO incompat pathophysiology
Dct usually wat
O mother affect A>B baby
Less effect as most AB are IgM
Some produce IgG anti A haemolysin o B haemolysin
Less severe anaemia,
no organomegaly
DCT pos but usually neg
Congenital infections get which bilirubinarmia
Conjugated
2causes for physiological jaundice
1. Increase bili load- Incr Hb Red life span 2- Reduce excretion Red ligandin Enz immatinc enterohepatic cir Slow gut motility Incr B glycuronydase Red bacteria in gut
Breast feeding-jaundice pathophysiology
Appear when
Mx
Poor BF and dehydration
Poor BF >increase enterohepatic circulation of bile>
1st week
Promote BF,EBM,FF
Infection cause which bilirubinemia and why
Both uncongugated and conjugated Uncongugated- Dehyd enterohepatic circ > Haemolysis Impaired liver
Main 2 symptoms of conjugated bili
Pale stools
Dark urine
Hepatomeg
Progression if jaundice spreading and resolving
Head to toe
Toe to head
Rate of change if jaundice
Inear rise and a plateau
Why preterm at high risk
Low albumin
Immature liver
Relationship BW jaundice and clinical status
Severely ill child more susceptible for
Damage from jaundice
2 main treatment modalities for NJ
Phototherapy
Exchange transfusion
Phototherapy light range?
Types 2
Complications 4
Blue 450 nm
Single &double
Dehydr,temperature instability ,
Rash and bronzed decouloration of eyes
ET done via and how,
How much
Umbilical vein
Withdrow 10-20ml blood and replace with donor blood
Twice the baby’s blood vol(80ml/kg*2)
Other new treatment methods for NJ
Immunoglobulins for baby
Albumin if low to baby
Explain Hb catabolism
In RES
Hb>heme+globin
Heme by heme oxygenase>fe,bili verdin ,CO
BIliverdin by biliverdine reductase>bilirubin
Binds to albumin and transported to liver.
In LIVER
Taken by ligand into cells.
Conjugated with 2UDP molec by UDP glycuronyl transferase
Excreted via bile.some goes to kidney via blood
In TERMINAL ILEUM
Deconj by B glycuronydase >reabsorption >enterohepatic cir to liver
In COLON
Bacterial action>urobilinogen>reabsorption >enterohepatic cir to liver(95%)
Rest converted to stercobilinogen>stercobilin>stool
Urobilinogen > urobilin>stools
In KIDNEY
Urobilinogen >urobilin >urine
How’s bili excreted in fetus
Unconjugated form via placenta
What other substance make bili
Myoglobin
Cytochrome
What are the physiological causes for jaundice with ex 5
1.^ bili -hemolysis,polycythemia ,haemorrages,^enterh cir
2.<uptake -
Premature ,genes
3. Absent o reduce enz amnt-
Gene Criggler najjar
4.reduce activity of enz-
Hypoxia,infection ,drugs,premature ,hypothyroid
5.obstruction -hepatitis,bili atresia
Risk factors for jaundice
J-Jaundice f
E-extravasated blood,enterohep cir
Symptoms if jaundice
Icterus Lethargy Poor feeding Seizure Anemia Hepatospleenagaly Pale stool Dark urine
Causes for congenital hyperbilirubinimi 5
Criggler najjar 1&2
Gilbert’s
Dubin Johnson
Rotors
Ix for jaundice
Early and late
SBR BLood Grp Rh DAT Hb Retic count Blood picture Septic screen
Late onset Above and Septic screen TFT LFT Urine for reducing subs Galactosemia screen Uss and HIDA scan to check bili syst TORCHS screen
Transc bili measurement
Use
Relationship to SBR
can’t use when
To screen
Parallel
To asses progress
CO measuring test
Use
ETCO-end tidal CO level
Ti asses bili production
Pys J appear ,peak,disappear when and adult level when
2-3d
2-4d
5-7d
19-14d
In preterms phy j rises how
Slow and prolonged
What factors exclude phy J
J5mg/dl
Term >12 preterm>14
Direct>2
Prolonged j
What's breast milk J Present when If BF continues what happens If stopped what happens Mx
Some milk has b glycuronydase which increase enterohepatic cir After 1 wk Slowly Reduse Rapidly drops Withhold BF for 1-2days and give FF PT
