Neonatal jaundice

Question 1

A billirubinometer can be used

Answer 1

Term neonates

Question 2

Neonatal pathological jaundice is found at

Answer 2

1 day of age

Question 3

Neonatal physiological jaundice is normally found at

Answer 3

3-5 days of age

Question 4

Percentage of term neonates which have physiological jaundice in the first week of life

Answer 4

60%

Question 5

Prolonged neonatal jaundice occurs after

Answer 5

14 days of age

Question 6

Risk factors for neonatal jaundice

Answer 6

Rhesus disease
G6PD
ABO incompatibility

Question 7

Physiology of jaundice

Answer 7

Bilirubin-red blood cell (albumin) - fetus have high haemoglobin and break down after being able to respirate on their own. RBC’s are then broken down and bilirubin part is transported with albumin to the liver

Liver: unconjugated to conjugated bilirubin → from fat-soluble to water-soluble
Energy and oxygen

Intestines reabsorption of bilirubin: meconium needs to be passed if there is a delay of excretion, bilirubin could be re-absorbed.

Question 8

Evaluation of jaundice

Answer 8

Maternal blood group: to know if mother is rhesus neg or O -/+

Sepsis: a baby fighting sepsis is using their energy stored to do so. So will not have enough energy to remove bilirubin

Bruising: difficult birth. More blood cells are damaged
Gestation: liver of 37w baby is not mature enough to deal with breaking down bilirubin. 37 weeks will have a different chart. Bilirubin levels are plotted in hours

Age of baby: age in hours

Ethnic origin: G6PD -make assessment of ethinic by looking at parents

Feeding history
Passed meconium
Previous sibling: if previous baby has had jaundice and phototherapy

Question 9

Measurement of Jaundice

Answer 9

Age of baby
Gestation
Bilirubinometer: sternum of the baby and can only be used in term babies
SBR
Threshold table
Treatment
Revised NICE guideline 2016 Neonatal jaundice

Question 10

Phototherapy

Answer 10

Parental concerns  
Equipment  
Eye protection  
Temperature control  
Dehydration-loose stools  
Nutrition and hydration 
Mother infant interaction  
Bili blanket

Question 11

Exchange transfusion

Answer 11

Exchange transfusion : An exchange transfusion is a blood transfusion in which the patient’s blood or components of it are exchanged with other blood or blood products. The patient’s blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine.

Threshold table
Transfer to NICU
Parental anxiety
Investigations

Question 12

Conjugated hyperbilirubinaemia

Answer 12

Conjugated hyperbilirubinaemia - preventing bilirubin from moving into the intestines.
Pale stools
Dark urine
Biliary atresia

Question 13

Unconjugated hyperbilirubin

Answer 13

• fat soluble high levels of bilirubin
  Infection: using energy levels
  Bruising: excess damage red blood cells that need to be broken down
  Polycythaemia: more RBC’s and when go warm or cry they go red
  Haemolytic disease of the newborn rhesus disease
  ABO incompatibility
  Genetic-G6PD

Question 14

Prolonged jaundice

Answer 14

Local guidelines

Referral for investigations