Neonatal jaundice Flashcards
What is the single most important question when a mother presents with her newborn who she thinks has jaundice?
When did the jaundice start
less than 24 hours (early)
24 hours to 2 weeks
> 2 weeks (late)
List 2 causes of early jaundice?
Less than 48 hours
Why is the baby haemolysing.
Pre hepatic causes including ABO incompatibility or hereditary spherocytosis. G6PD deficiency.
List 2 causes of intermediate neonatal jaundice?
Physiological Milk jaundice bruising, bleeding hypothyroid sepsis
List 2 causes of late jaundice?
Is it conjugated or unconjugated? Conjugated, post hepatic Biliary atresia (high conjugated bilirubin) Neonatal hepatitis Liver enzyme deficiency Breast milk jaundice (unconjugated)
Outline the time frames for physiological jaundice?
Traditional appears on day 3-4
peaks on 5-7 days
Resolves by 10-14 days
What proportion of neonates develop jaundice?
50%
What key clinical question needs to be answered in neonates who present with intermediate jaundice?
Is the bilirubin level too high to be in the normal range?
If a baby had early jaundice, what would your management plan be?
Refer back to hospital setting to get blood film, FBC, mother and baby blood group, coombs test for haemolysis.
In a baby with prolonged jaundice, what crucial question needs to be asked?
What is the colour of the stool? pale stools is bad
How common is breast milk jaundice?
1 in 20 babies breast fed get it.
Can last up to 16 weeks
How do you quantify the degree of jaundice?
Careful about rapidly rising bilirubinaemia and different races
Kramer’s rules
Icterometer
Serum bilirubin level if in doubt
Why is the detection, monitoring and treatment of jaundice important?
Prevent kernicterus - toxic effects of unconjugated bilirubin on brain.
Use the american academy of paediatrics treatment threshold guideline to determine if the bilirubin level if acceptable for the age of baby.
