Neonatal Jaundice

Question 1

When see jaundice in sclera?

Answer 1

Around 40

Question 2

When see jaundice in skin?

Answer 2

Around 80

Question 3

Factors in neonatal jaundice to consider?

Answer 3

Lighting
Skin colour
Thin sclera
Red skin when in baby

Question 4

Saturation of babies in utero?

Answer 4

50-60% , which is why they’re blue when born

Question 5

Reference range of bilirubin in adults

Answer 5

Less than 20

Question 6

How long does RBC live for in baby?

Answer 6

60 days

Question 7

Bilirubin cycle?

Answer 7

Haem-bilirubin-albumin-liver cell-defecate

Question 8

Why bilirubin unconjugated in fetus?

Answer 8

Because if conjugated, can’t cross placenta.

Question 9

Normal bilirubin level in fetus?

Answer 9

30-40

Question 10

how many babies get Hyperbilirubinaemia?

Answer 10

100%

Jaundice is different

Question 11

Brain damage from hyperbilirubinaemia affects what parts?

Answer 11

Basal ganglia and other gray matter areas

Athetoid CP

Question 12

Athetoid CP, IQ?

Answer 12

Not affected

Question 13

When worry about bilirubin levels in fetus? Threshold?

Answer 13

Greater than 340

Question 14

When does biliary atresia occur?

Answer 14

Not right at birth

Question 15

Jaundice in first 24 hours?

Answer 15

BIG TROUBLE.

Haemolysis

Question 16

Number 1 cause of haemolysis?

Answer 16

Antibodies - Rhesus D
ABO - usually doesn’t because IgM,
Coombs +ve. If IgG

Question 17

What test to see how many fetal cells in maternal blood?

Answer 17

Kleihauer Test

Question 18

Why is Kell so dangerous?

Answer 18

Expressed early, around 16 weeks

Question 19

Why is “c” antibodies important in testing?

Answer 19

Usually not tested in Rhesus tests. Need different test

Question 20

Hydrops

Answer 20

Thick, oedema, pulmonary oedema,

Question 21

If fetal Anaemia, how to treat?

Answer 21

Fetal transfusion

Delivery (depending on gestation)

Question 22

2 tests important in preg blood

Answer 22

Blood group

Indirect anti-globulin test

Question 23

G6PD, who’s likely to get it?

Answer 23

Males

X-linked

Question 24

What triggers G6PD?

Answer 24

Aspirin
Antimalarials
Moth balls: naphthalene - inhaled/transdermal, clothes or bedding

Question 25

What racial groups in G6PD?

Answer 25

Equatorial

Question 26

Membrane defects

Answer 26

Hereditary spherocytosis

Question 27

Hereditary spherocytosis what genetics?

Answer 27

Autosomal dominant

Question 28

Haemolysis, what to test?

Answer 28

``` ABO Enzymes: G6PD Membrane: HS Blood Group: Direct antibodies(on cell) Blood film: reticulocyte count ```

Question 29

What causes liver damage in neonate?

Answer 29

``` Galactesaemia CF TPN Hepatitis Biliary atresia ```

Question 30

Newborn screening tests?

Answer 30

CF PKU Thyroid (only TSH)

Question 31

Another less common cause of haemolysis for later cause of jaundice?

Answer 31

Sneaky Sepsis (UTI)

Question 32

What else can affect physiological jaundice severity?

Answer 32

Dehydration: under feeding | Birth trauma

Question 33

Rx of neonatal jaundice?

Answer 33

Phototherapy - blue light - isomerizes and allow excretion, protect their eyes. Exchange transfusion

Question 34

How to check for dehydration in neonate reliably?

Answer 34

Weight them

Question 35

Exchange transfusion is?

Answer 35

replace ALL the blood TWICE.

Question 36

Exchange transfusion blood bank, pH is? What to watch out for?

Answer 36

pH6.8 Big acid load, VQ mismatch, P02 drops, Need to give 02 and calcium(counter citrate in blood bags)

Question 37

Baby at 12 hours has bilirubin at 300 in the country hospital? What to do?

Answer 37

TRANSFER the baby. Throw phototherapy at it ASAP do blood groups and Coombs