Neonatal jaundice Flashcards
What are the symptoms and signs of newborn jaundice?
Yellowing of the skin and the whites of eyes,
In cholestasis, dark yellow urine and pale-coloured stools
When does jaundice usually appear in babies? And when will it go away?
Jaundice usually appear about 3 days after birth, and will disappear by 2 weeks old.
What is the complication of untreated jaundice in new-borns?
Kernicterus, a condition caused by excess bilirubin damaging the brain or CNS
What are the initial signs of Kernicterus?
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
What are the treatment options for new-born jaundice?
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).
On percussion of a child’s chest who is suffering from bronchiolitis, what is found?
Hyper-resonant
What are the causes of new-born jaundice?
Physiological jaundice
Breast-milk jaundice
Haemolytic disease of the new-born
Biliary atresia
What is the cause of physiological jaundice?
Physiological jaundice occurs due to immature hepatocytes not being able to adequately conjugate bilirubin.
How is breast-milk jaundice diagnosed?
Breast milk jaundice is a diagnosis of exclusion.
When does breast-milk jaundice manifests? How long can it persist for?
Breast-milk jaundice manifests by days 4-7 and can persist for 3 weeks to 3 months.
What are the 2 most common causes of Haemolytic disease of the new-born?
ABO or rhesus incompatibility.
Are there any changes to stools and urine in breast-milk jaundice children?
No, the stools and urine are normal
When does jaundice in new-borns require investigations?
Investigations are needed if jaundice occurs in the first 24 hours or last beyond 2 weeks.
What is given to Rhesus negative mothers to prevent development of Haemolytic disease of newborn?
All Rhesus negative women are routinely immunised with anti-D antibodies at 28 weeks, to prevent stimulation of maternal IgG production.
What is measured in those suspected with breast-milk jaundice? What will this test rule out?
Split bilirubin is measured to rule out conjugated hyperbilirubinaemia.
What will neonates present with in untreated rhesus disease?
There will be fetal anaemia and severe jaundice.
What is Biliary Atresia?
Biliary atresia is caused by the absence of intra- or extra-hepatic bile ducts
In biliary atresia, is there more conjugated or unconjugated bilirubin? By how much?
In biliary atresia, there is accumulation of conjugated bilirubin (conjugated hyperbilirubinaemia). Split bilirubin test reveals >20% of conjugated bilirubin among total bilirubin.
What is the commonest cause of jaundice in older children?
Hepatitis A infection
What can prolonged jaundice increase the risk of?
What investigations and management are done?
Prolonged jaundice can increase the risk of bleeding disorders associated with vitamin K deficiency.
Coagulation screen is done and vitamin K supplements are given.
