Neonatal jaundice

Question 1

What is neonatal jaundice?

What is physiological jaundice?

Answer 1

=jaundice in a baby <28days old (jaundice bilirubin>30mmol/L)

-starts at 24hrs
-peaks few days
-resolves 14 days
-if more than 260mm/L = treat
(Foetal haemoglobin has a shorter life span than adult haemoglobin and is constantly being broken down at a high rate.
The newborn liver cannot cope with all of this bilirubin, and so it builds up in the blood)

Question 2

What could cause jaundice <24hrs?

Answer 2

• spherocytosis
• G6PD
• ABO incompatability
• Congenital infection (TORCH)
• Rhesus haemolytic disease

Question 3

What could cause jaundice between 24hrs-2weeks?

Answer 3

• physiological
• breast milk jaundice
• bruising
• infection
• haemolytic disorder
• bruising

Question 4

What could cause jaundice >2weeks due to unconjugated bilirubin?

Answer 4

• physiological
• breast milk jaundice
• infection
• hypothyroid
• haemolytic disorders

Question 5

What could cause jaundice >2wks due to conjugated bilirubin?

Answer 5

-sepsis
-TPN
-Biliary atresia is a rare condition in which all or parts of the biliary tree fail to develop, preventing bile from flowing into the gut.
-neonatal hepatitis
-C.F
(pale or chalky white stools with dark urine)

Question 6

Why is neonatal jaundice dangerous?

Answer 6

-serum unconjugated bilirubin can = deafness, kernicterus, athetoid cerebral palsy

Question 7

How can kernicterus present?

Answer 7

• lethargy
• poor feeding
• irritable
• increased tone

Question 8

What investigations are done for neonatal jaundice?

Answer 8

• urine dip +/- culture
• imaging USS liver - biliary atresia
• liver biopsy
• nuclear medicine liver scans

Bloods:

• FBC and film
• blood group, direct coombs
• cap. blood gas
• serum BR
• consider others e.g. septic screen

Question 9

What is the management of neonatal jaundice?

Answer 9

• phototherapy is unconjugated
• encourage regular feeding
• exchange transfusion

Question 10

What are the TORCH infections?

Answer 10

Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections

Question 11

Why does infection cause jaundice?

Answer 11

• poor fluid intake
• haemolysis
• reduced hepatic function
• increase enterhepatic circulation