Neonatal Jaundice Flashcards
Describe Jaundice…
In utero, baby’s receive oxygen and nutrients from maternal blood supply. For this purpose they have a high number of red blood cells with a high affinity for oxygen. Once born these red blood cells are broken down which produces haem and globin and iron. Haem is converted to fat soluble bilirubin. Bilirubin binds to albumin and travels to the liver where it is converted to water soluble conjugated bilirubin. It then travels to the intestine where bacteria turns it into urobillogen. It is then excreted.
Jaundice occurs when unconjugated billirubin is not excreted at the same rate as it is being produced. It is stored in the fact cells in the skin and schlera and causes babies to appear yellow. If left untreated, levels can be toxic and it can lead to kernicterus if unconjugated bilirubin enters the brain.
Describe the differences between pathological and physiological jaundice…
Physiological jaundice appears after 24 hours of life and is very common. This is due to:
Babies have low albumin levels which delays the transportation of unconjugated bilirubin to the liver and delays excretion.
Babies also have immature gut bacteria which delays excretion.
Babies may appear sleepy and be reluctant to feel. Feeding regularly can help this and it should clear up on its own by day 7. Blood serum levels never exceed 200-215.
Pathological jaundice occurs within 24 hours and it is when an underlying issue is interrupting the normal system of bilirubin excretion from the body. It is characterised by persistent and rapid increase in serum bilirubin levels.
List some causes of pathological jaundice
ABO and rhesus isoimmunisation, cephal haematoma, sepsis, polycythaemia, sickle cell all cause increased RBC breakdown.
Hypothermia, hypoxia, acidosis all cause reduced albumin levels and reduced transportation of bilirubin to the liver.
Hypoxia, hypothermia, hypoglycaemia and infection mean baby has less energy for conugation.
Obstruction or infection in the gut can cause delayed excretion of bilirubin.
Care plan for pathological Jaundice babies (with reference)
(NICE, 2010)
Identify at-risk babies (premature, LBW, BF, visible jaundice within 24 hours.
Give written and verbal information to all parents along with consent. Inform them of what to look out for such as pale chalky stools, dark urine, lethargy, not feeding.
Women should be encouraged to keep feeding and should be well supported in this.
Baby should be examined fully naked at the first opportunity in a good light. NICE does not suggest routine testing of bilirubin levels if not indicated.
If there is suspected jaundice within 24 hours, test serum bilirubin levels immediately and continue to test 6 hourly. Arrange for medical urgent review to exclude pathological causes.
Possible feeding plan
Phototherapy/exchange transfusion
What information should you give parents about what to look out for?
Chalky stools, letahrgy, poor feeding, yellow discolouration of the skin.
Babies should keep feeding regularly, keep good temeoperature and if under phototherapy should take short breaks for BF. Expressing should be supported.
What is prolonged jaundice and what can be done about it?
Prolonged jaundice lasts >14 days. Do FBC Measure conjugated bilirubin Anti-D? Metabolic screening - heel prick Liver disease Offer exchange transfusion
Care plan for physiological jaundice
If over 24 hours, bilirubin can be measured with a bilirubinometer. If bilirubin levels are above the threshold on individual chart check SBR.
If a baby with physiological jaundice requires phototherapy requires phototherapy repeat SBR 4-6 hours after commenced and every 6-12 hours when it is falling. Phototherapy can be stopped once it is below the threshold line.
Babies should be checked for any rebound.
What should babies at risk have?
An additional visual inspection within 48 hours.
How should SBR results be interpreted?
According to PN age in hours, threshold table and threshold graph.
Information for parents whose babies are being treated with phototherapy for hyperbilirubinaemia
Why phototherapy is being done. Possible adverse effects Eye protection Reassurance that short breaks for feeding changing and cuddles are encouraged. Babies temperature should be monitored Assess wet nappies
When are babies more likely to get kernicterus?
Rapidly rising SBR
Clinical features of bilirubin ecephalopathy
When should IV immunoglobin be used?
If there is haemolytic disease of newborn or ABO incompatibility
Exchange transfusion
The most intensive treatment is exchange transfusion which is used if the threshold table indicates or there are signs of acute bilirubin ecephalopathy.
Jaundice reference to use?
NICE, 2010
