Neonatal jaundice Flashcards
1
Q
What 3 processes underly the high rate of neonatal jaundice?
A
- increased haemolysis (Hb F)
- reduced conjugating ability (immature liver)
- increased enterohepatic circulation of BR (increased levels of B-glucuronidase in gut)
2
Q
What are the most common causes of neonatal jaundice?
A
- physiological jaundice
- breastfeeding jaundice
- breastmilk jaundice
3
Q
What are causes of jaundice in <24 hrs?
A
- immune haemolysis (Rh disease, ABO incompatibility)
- non-immune haemolysis (sepsis, G6PD def)
4
Q
What causes BR encephalopathy?
A
- unbound unconjugated BR is fat soluble and crosses BBB
- toxic to mitochondria in the basal ganglia and neonatal brain
5
Q
5 complications of severe immune haemolysis
A
- anaemia
- BR encephalopathy
- dyskinetic CP
- sensorineural hearing loss
- intellectual impairment
6
Q
How does phototherapy work?
A
Photo-isomerisation of tissue BR to lumirubin which is water soluble and excreted in the urine
7
Q
How do you optimize the dose of phototherapy?
A
- use a strong light
- use the right wave length light (blue LED)
- bring light closer to baby (30-40cm)
- ensure maximum skin exposure
8
Q
What causes conjugated hyperBR in neonates?
A
- biliary atresia
- choledocal cyst
- neonatal hepatitis
- TPN hepatitis
- rarer causes like a-1-antitrypsin def
9
Q
What is the surgery for biliary atresia called?
A
- Kasai procedure
10
Q
What are the commonest causes of neonatal hepatitis?
A
- CMV
- cong. syphilis
- idiopathic giant cell hepatitis
- TPN hepatitis
- cong. rubella infection
