Neonatal jaundice

Question 1

What are the symptoms and signs of newborn jaundice?

Answer 1

Yellowing of the skin and the whites of eyes,

In cholestasis, dark yellow urine and pale-coloured stools

Question 2

When does jaundice usually appear in babies? And when will it go away?

Answer 2

Jaundice usually appear about 3 days after birth, and will disappear by 2 weeks old.

Question 3

What is the complication of untreated jaundice in new-borns?

Answer 3

Kernicterus, a condition caused by excess bilirubin damaging the brain or CNS

Question 4

What are the initial signs of Kernicterus?

Answer 4

Decreased awareness of their surroundings - for example, they do not react when you clap your hands in front of them.

Muscles becoming floppy

Poor feeding

Question 5

What are the treatment options for new-born jaundice?

Answer 5

Phototherapy: helps to lower the bilirubin levels through photo-oxidation. Converts unconjugated bilirubin to biliverdin, an isomer that can be secreted by the kidneys.

Blood exchange transfusion: in rhesus or ABO incompatibility, to remove bilirubin and maternal IgG antibodies from circulation.

IVIG Intravenous Immunoglobulin may be used if jaundice is caused by rhesus disease (mother has rhesus-negative blood and baby has rhesus-positive blood).

Question 6

On percussion of a child’s chest who is suffering from bronchiolitis, what is found?

Answer 6

Hyper-resonant

Question 7

What are the causes of new-born jaundice?

Answer 7

Physiological jaundice
Breast-milk jaundice
Haemolytic disease of the new-born
Biliary atresia

Question 8

What is the cause of physiological jaundice?

Answer 8

Physiological jaundice occurs due to immature hepatocytes not being able to adequately conjugate bilirubin.

Question 9

How is breast-milk jaundice diagnosed?

Answer 9

Breast milk jaundice is a diagnosis of exclusion.

Question 10

When does breast-milk jaundice manifests? How long can it persist for?

Answer 10

Breast-milk jaundice manifests by days 4-7 and can persist for 3 weeks to 3 months.

Question 11

What are the 2 most common causes of Haemolytic disease of the new-born?

Answer 11

ABO or rhesus incompatibility.

Question 12

Are there any changes to stools and urine in breast-milk jaundice children?

Answer 12

No, the stools and urine are normal

Question 13

When does jaundice in new-borns require investigations?

Answer 13

Investigations are needed if jaundice occurs in the first 24 hours or last beyond 2 weeks.

Question 14

What is given to Rhesus negative mothers to prevent development of Haemolytic disease of newborn?

Answer 14

All Rhesus negative women are routinely immunised with anti-D antibodies at 28 weeks, to prevent stimulation of maternal IgG production.

Question 15

What is measured in those suspected with breast-milk jaundice? What will this test rule out?

Answer 15

Split bilirubin is measured to rule out conjugated hyperbilirubinaemia.

Question 16

What will neonates present with in untreated rhesus disease?

Answer 16

There will be fetal anaemia and severe jaundice.

Question 17

What is Biliary Atresia?

Answer 17

Biliary atresia is caused by the absence of intra- or extra-hepatic bile ducts

Question 18

In biliary atresia, is there more conjugated or unconjugated bilirubin? By how much?

Answer 18

In biliary atresia, there is accumulation of conjugated bilirubin (conjugated hyperbilirubinaemia). Split bilirubin test reveals >20% of conjugated bilirubin among total bilirubin.

Question 19

What is the commonest cause of jaundice in older children?

Answer 19

Hepatitis A infection

Question 20

What can prolonged jaundice increase the risk of?

What investigations and management are done?

Answer 20

Prolonged jaundice can increase the risk of bleeding disorders associated with vitamin K deficiency.
Coagulation screen is done and vitamin K supplements are given.