Neonatal Jaundice

Question 1

What is the most common cause of jaundice in the first 24 hours of life?

Answer 1

• Always pathological in this period
• Haemolysis
• Congenital infection

Question 2

Describe the investigations you would undertake in a neonate presenting with jaundice in its early stages

Answer 2

• Bilirubin (severity)
• FBE and film
• Group and antibodies (haemolysis)
• Maternal group (haemolysis)
• Direct Coombs test (immune?)
• G6PD levels

Question 3

After the first 24 hours of life, what are the most common and most important causes of neonatal jaundice?

Answer 3

• Physiological
• Sepsis
• Breast milk jaundice (inadequate intake and dehydration)
• Conjugated (obstruction, atresia, hepatitis)
• Unconjugated (others above)

Question 4

In a neonate, what factors can exacerbate physiological jaundice?

Answer 4

• Prematurity
• Sepsis
• Bruising
• Cephalohaematoma
• Polycythaemia
• Delayed meconium
• Breast feeding

Question 5

If a neonate presented with prolonged jaundice, what investigations might you consider?

Answer 5

• LFTs, coags, abdominal ultrasound (GB), DISIDA/HIDA scan, TFTs, metabolic screen, hepatitis/TORCH screen, liver biopsy
• Normal jaundice screen - FBE and film, group, maternal group, direct Coombs test

Question 6

What is kernicterus? What are some signs of severity?

Answer 6

• Unconjugated bilirubin encephalopathy
  
  • Phase 1 - hypotonia, poor suck
  • Phase 2 - hypertonia, opisthonos (like oculogyric crisis)
  • Phase 3 - high pitched cry, loss of vision/hearing, athetosis (writhing)

Question 7

Describe the principles of treatment of neonatal jaundice

Answer 7

• Unconjugated
  
  • Fluids, phototherapy, IVIG, exchange transfusion (rare)
• Conjugated
  
  • Treat underlying problem

Question 8

At what level is hyperbilirubinaemia detectable by eye?

Answer 8

80 nmol/L