Neonatal Jaundice Flashcards
What is the management of pathological Jaundice?
- Notify the GPO immediately on the finding.
- The GPO will contact the on-call paediatrician immediately for review of the neonate in the nursery.
- An SBR must be taken and bloods for Group and DAT (otherwise known as direct COOMBS), a full blood picture (FBP) and septic screen.
- Consider admission to the NNU for triple phototherapy, insertion of a nasogastric tube (NGT), weight pre-phototherapy and intravenous cannula (IVC)/intravenous therapy (IVT). Treatments are at the discretion/guidance of the admitting Paediatrician).
- A repeat SBR should be taken 4-6 hours after commencement of the triple lights, to determine if a transfusion is required or transfer to a tertiary centre is appropriate.
What is the point of phototherapy?
The primary role of phototherapy is to lower the concentration of circulating unconjugated bilirubin to a level at which the risk of central nervous system deposition is minimised, thus avoiding the deleterious consequences of acute and/or chronic encephalopathy
How do you prepare the neonate and mother for phototherapy?
- Check the SBR result against the phototherapy graph
- Paediatrician review
- Paediatrician is to inform the midwife of the preferred regime
- Paediatrician may order COOMBS, G6PD, CRP and SBR
How do you prepare the neonate and mother for phototherapy?
- Check the SBR result against the phototherapy graph
- Paediatrician review
- Paediatrician is to inform the midwife of the preferred regime
- Paediatrician may order COOMBS, G6PD, CRP and SBR
- Obtain verbal consent
- Prepare isolette and lights at bedside 30-34ºC
- Educate parents on use of cot
- Document
What is the management of neonate during phototherapy?
- weigh and baseline obs
- remove clothing
- do not use lotions or creams
- put eye shields on baby
- place neonate on back in isolette
- Document time of start and when neonate is out for feeds (not more than 45 mins)
- encourage demand feeding but not more than 3-4 hourly
- consider artifical feeding 10% more per light per feed
- NGT if not tolerating extra feed
- record PU & BO every 3-4 hours
- Pre feed daily weight every morning
- SBR level 4-6 hourly
- Stork update
- Document all care provided
What are the complications of phototherapy?
Hyperthermia or hypothermia Dehydration Bronze infant syndrome - may occur with neonates who have cholestasis Diarrhoea Parental anxiety/separation Skin rash Potential retinal damage Disruption of mother - neonate bonding Increased length of hospital stay
What is the follow up care post phototherapy?
- repeat SBR 24 hours later
- continue 3- 4 hourly feeds at home
- educate families about signs and symptoms of jaundice
Define pathological Jaundice?
Pathological jaundice is related to a condition other than normal newborn bilirubin being processed slowly by an immature liver. Such conditions include an incompatibility between the baby’s and the mother’s blood types, incompatibility of additional blood factors, or liver problems. There is actual pathology involved that might require more aggressive and lengthier intervention than physiological bilirubin problems.
What are the differences between pathalogical and physiological jaundice?
Visible jaundice in first 24 hours of life. However slight jaundice on face at the end of first day
(say 18 to 24 hr) is common and can be considered physiological.
2. Presence of jaundice on arms and legs on day 2
3. Yellow palms and soles anytime
4. Serum bilirubin concentration increasing more than 0.2 mg/dL/hour or more than 5 mg/dL in 24
hours
5. If TSB concentration more than 95th centile as per age-specific bilirubin nomogram
6. Signs of acute bilirubin encephalopathy or kernicterus
7. Direct bilirubin more than 1.5 to 2 mg/dL at any age
8. Clinical jaundice persisting beyond 2 weeks in term and 3 weeks in preterm neonates
