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Appreciating Complex Midwifery Care > Neonatal Jaundice > Flashcards

Neonatal Jaundice Flashcards

1
Q

What is haemolysis and what are the products?

A
  • Breakdown of RBC

- Produces unconjugated bilirubin (haem), globin and iron

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2
Q

What do babies have an abundance of at birth?

A

RBC

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3
Q

How does unconjugated bilirubin travel around the body?

A

Binds to albumin but some is free and able to enter the brain

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4
Q

How does unconjugated bilirubin affect the body?

A

It is fat soluble so travels to areas of fat in the body and stains them (skin, eyes, gums, roof of mouth)

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5
Q

What happens to unconjugated bilirubin when it reaches the liver?

A

It is metabolised in the liver to produce conjugated bilirubin which then passes into the gut and is converted to urobilinogen and excreted in urine and faeces

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6
Q

What is SBR?

A

Serum bilirubin - amount of bilirubin in the blood

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7
Q

What is physiological jaundice and when does it occur?

A

Slightly raised SBR at day 3-5

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8
Q

Give the word formula for the process of unconjugated bilirubin breaking down

A

Unconjugated bilirubin -> Glucose + Glucaronic acid + Bilirubin -> (enzyme Gluceronyl transferase) = Conjugated bilirubin -> Urobilinogen

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9
Q

What is the main property of conjugated bilirubin?

A

Water soluble

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10
Q

What is the definition of Jaundice according to NICE (2015)?

A

Jaundice refers to the yellow colouration of the skin and the sclerae (whites of the eyes) caused by the accumulation of bilirubin in the skin and mucous membranes

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11
Q

What is another name for Jaundice?

A

Hyperbilirubinaemia

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12
Q

How many babies develop Jaundice in the first week of life?

A 
Term = 60%
Preterm = 80%
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13
Q

Are bottle or breast fed babies more likely to develop physiological Jaundice?

A

Breastfed

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14
Q

What is prolonged Jaundice?

A
  • Jaundice persisting beyond 14 days (term) or 21 days (preterm)
  • Generally harmless but can be an indication of severe liver disease
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15
Q

What is clinical Jaundice?

A

Jaundice that is visually detectable

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16
Q

What is significant Hyperbilirubinaemia?

A

An elevation of the SBR to a level requiring treatment

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17
Q

Which types of Jaundice require investigation/ treatment?

A
  • Pathological Jaundice
  • SBR continues to rise rapidly between days 3 and 4
  • Prolonged Jaundice
  • Has abnormally high SBR
  • Baby shows signs of being unwell
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18
Q

What is pathological Jaundice?

A

Jaundice before 24 hours old

  • Usually caused by blood incompatibility
  • SBR rises very rapidly
  • Paediatric emergency - NICE say baby should be admitted to neonatal unit within 2 hours
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19
Q

What causes Jaundice?

A
  1. Increased haemolysis of RBC
  2. Prematurity
  3. Decreased albumin binding capacity
  4. Competition for albumin binding sites
  5. Lack of/ reduction in enzymes and carrier proteins
  6. Lack of oxygen and glucose
  7. Hepatitis/ liver damage
  8. Congenital biliary atresia
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20
Q

How does increased haemolysis of RBC cause pathological Jaundice?

A
  • Rh isoimmunisation or ABO incompatibility
  • Congenital spherocytosis/ red cell abnormalities
  • Sepsis
  • Bruising/ Cephalohaematoma
  • Polycythemia
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21
Q

What is Congenital Spherocytosis?

A

Shortage of RBC

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22
Q

What is Polycythemia?

A

Increased haematocrit

  • Twin to twin/ materno-foetal transfusion
  • SFD infants
  • Infants of diabetic mothers
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23
Q

What is haematocrit?

A

The ratio of Volume of RBC: Volume of blood

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24
Q

How does prematurity cause pathological Jaundice?

A
  • Immaturity of the liver
  • Low energy stores
  • Poor feeding
  • Lower levels of SBR will cause brain damage in preterm babies
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25
Q

What are the risks of decreased albumin binding capacity?

A
  • Hypoxia and acidosis
  • Infection
  • Prematurity
  • Hypoglycaemia
26
Q

What competes for albumin binding sites?

A
  • Free fatty acids (starvation and cold stress)

- Drugs (sulphonamides, cephalosporins, diazepam IV, frusemide, heparin)

27
Q

What might cause a reduction of enzymes or carrier proteins?

A
  • Congenital disorders

- Prematurity

28
Q

What may cause a lack of oxygen and glucose?

A
  • Prolonged stress in utero
  • Stress in SFD infants
  • Hypoxia at birth
29
Q

What may cause liver damage?

A
  • Metabolic disorders (e.g. galactosaemia)

- Infection

30
Q

What is congenital Biliary Atresia?

A
  • Rare disorder where part of the liver that drains into the bile duct is abnormally formed
  • Early surgery can prevent liver damage so early detection is vital
  • Late diganosis = baby could die without a liver transplant
31
Q

What are some causes of slow bowel motility?

A
  • Poor feeding
  • Pyloric stenosis/ bowel obstruction
  • Congenital hypothyroidism
32
Q

What is a meconium plug?

A
  • Takes longer to come out
  • Harder, like an actual stool
  • Often mixed with mucous
  • Inform Paed immediately
33
Q

What are the dangers of pathological Jaundice?

A
  • Bilirubin levels are generally higher than in physiological Jaundice
  • Levels remain high for longer
  • Much higher risk of Kernicterus
  • Causes may be harmful to the baby
34
Q

What is the urgent care for a baby with pathological Jaundice?

A
  • Measure and record the SBR level urgently (within 2 hrs)

- Continue to measure SBR every 6 hrs until the level is below the treatment threshold

35
Q

What is ABO incompatibility?

A

Mother = Type O
Baby = Type A or B
If sensitising event occurs, anti-A/B antibodies are produced
Affects 2nd pregnancy and can cause Jaundice

36
Q

Which is more severe; Rh isoimmunisation or ABO incompatibility?

A

Rh isoimmunisation

37
Q

Describe Jaundice that is caused by infection

A
  • SBR tends to rise steadily
  • Starts to rise related to the time of infection
  • If intrauterine infection, may appear in 48 hrs
38
Q

What should be done for a baby with prolonged Jaundice?

A

Split bilirubin test

If conjugated bilirubin >20% or total bilirubin >200mmol/l, refer to paed

39
Q

What are the dangers of jaundice?

A
  • Unconjugated bilirubin can penetrate the membrane that lies between the brain and the blood (blood-brain barrier)
  • Unconjugated bilirubin is potentially toxic to neural tissue (brain and spinal cord) and can cause short and long term neurological dysfunction
40
Q

What is Kernicterus?

A

The clinical features of acute/chronic bilirubin encephalopathy and the yellow staining of the brain which is associated with this

41
Q

What is Bilirubin Encephalopathy?

A

Brain disease/infection caused by high bilirubin levels

42
Q

How does Kernicterus present in the newborn?

A

Progressive development of lethargy, rigidity, high pitched cry and convulsions over 24 hrs

43
Q

What information should be given to parents when they leave the hospital?

A
  • What factors might influence the development of Jaundice
  • How to check their baby for Jaundice
  • What they should do
  • The importance of seeking urgent help if it occurs before 24 hours
44
Q

What excretory signs could there be that a baby is Jaundiced according to NICE (2015)?

A
  • Pale, chalky stools

- Dark urine

45
Q

What should be used to measure bilirubin levels?

A

Transcutaneous Bilirubinometer (baby must be >35/40 and over 24 hrs old)

46
Q

What should be done if the bilirubin measurement is >250mmol/l?

A

Measure serum bilirubin (blood test)

47
Q

In what situation should serum bilirubin be measured straight away?

A
  • Pathological Jaundice
  • Born <35/40
  • Babies that are at/above relevant treatment threshold
48
Q

Why is adequate feeding important?

A
  • Breast milk speeds passage of meconium, increasing conversion in bowel to conjugated bilirubin
  • Energy for liver function
  • Fluid for baby under phototherapy
49
Q

Why should supplementary fluid be avoided?

A

This could reduce the intake of breast milk

50
Q

What information should be given to parents with babies requiring treatment?

A
  • Anticipated duration of treatment
  • Reassurance that BF, nappy-changing and cuddles can usually continue
  • Lactation/feeding support
51
Q

What are perspex covers used for?

A
  • Protect from skin irritation and assist thermoregulation
  • Do not reduce effectiveness of phototherapy
  • Used for term babies only
52
Q

How does phototherapy work?

A

Changes bilirubin under the skin from its unconjugated form to non-toxic bilirubin products that can be excreted without conjugation by the liver

53
Q

When does phototherapy work most effectively?

A

In the first 48 hours of use

54
Q

What are the advantages of biliblankets?

A
  • Remove the need for eye covering

- Less stressful for mother and baby

55
Q

How should a baby undergoing phototherapy be cared for?

A
  • Frequent observations
  • Regular feeding
  • Protect eyes
  • Nurse baby naked (skin to skin)
  • Temperature control
56
Q

What is intensified phototherapy?

A
  • Can be intensified by using another light source of increasing light intensity
  • Do not interrupt phototherapy for feeds (use enteral feeds/ IV
  • Encourage EBM so BF can resume after treatment
57
Q

What is conventional phototherapy?

A

Phototherapy given using a single light source that is positioned above the baby

58
Q

What is fibreoptic phototherapy?

A

Phototherapy given using a single light source that comprises a light generator, a fibreoptic cable through which the light is carried and a flexible light pad on which the baby is placed or that is wrapped around the baby

59
Q

What is multiple/ intensified phototherapy?

A
  • Phototherapy that is given using more than one light source simultaneously
  • 2+ conventional units or a combination of conventional and fibreoptic units
  • SBR very high so have 1 light above and 1 at side or 1 light above and 1 biliblanket
60
Q

What is an exchange transfusion?

A
  • Complete changeover of blood if SBR is too high
  • Removes maternal antibodies
  • Check SBR 2 hrs after change
  • 0.3-0.4% mortality
  • 5-10% permanent sequelae
61
Q

Give 3 permanent sequelae that may result from an exchange transfusion?

A
  • Aortic thrombosis
  • Intraventricular haemorrhage
  • Pulmonary haemorrhage

Appreciating Complex Midwifery Care (14 decks)

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