neonatal jaundice

Question 1

what symptoms may the neonate with jaundice get?

why is it bad for these neonates to be dehydrated?

Answer 1

• lethargy, anorexia

- Dehydration causes haemoconcentration, making the baby feed less well hence causing more severe dehydration

Question 2

what are the causes of unconjugated hyperbilirubinaemia? (8)

Answer 2

• Rhesus and ABO incompatibility
• infection (TORCH)
• excessive bruising
• internal haemorrhage
• prematurity
• hypothyroidism
• breast milk jaundice
• physiological

Question 3

what are the causes of conjugated hyperbilirubinaemia? (3)

Answer 3

• neonatal hepatitis
• Cystic fibrosis
• biliary atresia

Question 4

what two reasons make jaundice clinically important?

Answer 4

• can cause irreversible brain damage (kernicterus)
• kernicterus causes deafness, cerebral palsy and retardation
• prolonged jaundice may indicate severe underlying disease

Question 5

what should you suspect if a baby has conjugated hyperbilirubinaemia?

Answer 5

• CF
• neonatal hepatitis
• biliary atresia

Question 6

what other symptoms may these neonates have?

Answer 6

• hepatosplenomegaly
• petechiae
• anaemia

Question 7

What does the Coombs test test for?

Answer 7

• determines whether there is an antibody on the RBC membrane
• (positive in rhesus incompatibility)

Question 8

There are 4 indications that a baby should be investigated rapidly for serious causes of jaundice, what are they?

Answer 8

• 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)

Question 9

how can you tell the total bilirubin level just by looking at baby?

Answer 9

• limited to head and neck (mild)
• over trunk and thighs (moderate)
• Extending to hands and feet (severe)

Question 10

why might you do a lumbar puncture and urine cultures in jaundice?

Answer 10

• meningitis/ infection causing it

Question 11

how should these babies be treated?

Answer 11

• 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

Question 12

what does jaundice in 1st 24 hours suggest?

Answer 12

• haemolysis or sepsis

Question 13

what signs are there of kernicterus?

Answer 13

• irritability
• high pitch cry
• coma