neonatal jaundice Flashcards
what symptoms may the neonate with jaundice get?
why is it bad for these neonates to be dehydrated?
- lethargy, anorexia
- Dehydration causes haemoconcentration, making the baby feed less well hence causing more severe dehydration
what are the causes of unconjugated hyperbilirubinaemia? (8)
- Rhesus and ABO incompatibility
- infection (TORCH)
- excessive bruising
- internal haemorrhage
- prematurity
- hypothyroidism
- breast milk jaundice
- physiological
what are the causes of conjugated hyperbilirubinaemia? (3)
- neonatal hepatitis
- Cystic fibrosis
- biliary atresia
what two reasons make jaundice clinically important?
- can cause irreversible brain damage (kernicterus)
- kernicterus causes deafness, cerebral palsy and retardation
- prolonged jaundice may indicate severe underlying disease
what should you suspect if a baby has conjugated hyperbilirubinaemia?
- CF
- neonatal hepatitis
- biliary atresia
what other symptoms may these neonates have?
- hepatosplenomegaly
- petechiae
- anaemia
What does the Coombs test test for?
- determines whether there is an antibody on the RBC membrane
- (positive in rhesus incompatibility)
There are 4 indications that a baby should be investigated rapidly for serious causes of jaundice, what are they?
- evidence of jaundice in the 1st 24 hours of life, suggesting underlying haemolysis
- clinical evidence of deep jaundice
- prolonged conjugated jaundice lasting more than 2 weeks, suggesting a serious underlying cause
- increasing levels of conjugated bilirubin (suggesting a severe hepatic cause)
how can you tell the total bilirubin level just by looking at baby?
- limited to head and neck (mild)
- over trunk and thighs (moderate)
- Extending to hands and feet (severe)
why might you do a lumbar puncture and urine cultures in jaundice?
- meningitis/ infection causing it
how should these babies be treated?
- avoid kernicterus, have a look at charts to see level of unconjugated bilirubin that is dangerous
- phototherapy (unconjugated)
- exchange transfusions
- treat the cause in conjugated- much more worrying
what does jaundice in 1st 24 hours suggest?
- haemolysis or sepsis
what signs are there of kernicterus?
- irritability
- high pitch cry
- coma