Neonatal Jaundice

Question 1

What is the avg. half-life of fetal RBCs?

Answer 1

~60 days

Question 2

Why is fetal bilirubin unconjugated?

Answer 2

Unconjugated bilirubin can cross the placenta

Question 3

What is physiological jaundice?

Answer 3

Fetal bilirubin rises after birth, peaks at day 3 (around 200-250 mmol/L), and usually resolves within the first week of life (two if premature).

Question 4

What is the complication of high unconjugated bilirubinaemia? What are the symptoms?

Answer 4

Kernicterus - bilirubin-induced brain dysfunction
Symptoms:
-hypo/hypertonia
-seizures
-lethargy
-opisthotonus (hyperextension)
-auditory dysfunction (deafness)
-cerebral palsy

Question 5

DDx of Jaundice in first 24 hours

ALWAYS ABNORMAL

Answer 5

1) HAEMOLYSIS
2) G6PD Deficiency
3) Membrane defects (Hereditary Spherocytosis)
4) Sepsis! (Must exclude)

Question 6

DDx of Persistent Jaundice

Answer 6

• Breastfeeding Jaundice (not enough, slow GIT transport causes higher reabsorption)
• Breast milk jaundice (thriving, healthy infant, may last 3 months, unconjugated)
• hypothyroidism
• obstructive causes (CONJUGATED; biliary/duodenal atresia, pyloric stenosis)
• infections (listeria, toxo, hep B, CMV, rubella, parvo)

Question 7

Investigations of neonatal jaundice

Answer 7

• FBE, Hb, and film
• Blood group, DAT/IAT, Kleihauer (haemolysis)
• TFTs
• liver USS (obstructive causes)
• liver biopsy

Question 8

Management of Neonatal Jaundice

Answer 8

• phototherapy (SE: diarrhoea- monitor weight, hyperthermia, retinal damage-use sunglasses)
• exchange transfusion (SE: hypoxia with acidic stored blood- give O2 and monitor oximetry)
• ABx if septic
• adequate caloric intake