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Paeds > Neonatal jaundice > Flashcards

Neonatal jaundice Flashcards

1
Q

Why do neonates have a high risk of jaundice compared to infants

A

Higher enterohepatic circulation so less bilirubin excretion
Decreased RBC lifespan
Increased number of RBC
Immature hepatic conjugation of bilirubin

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2
Q

What is pathological jaundice

A

<24 hours of life

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3
Q

Causes of jaundice in <24 hours

A

Sepsis - check group B streptococci

ABO/Rh incompatibility = haemolytic disease of the newborn

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4
Q

What is physiological jaundice

A

2-14 days

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5
Q

What is prolonged jaundice

A

> 2 weeks

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6
Q

Causes of jaundice in days 2-14

A

Breastfeeding
Sepsis (on day 2)
Polycythaemia

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7
Q

Causes of prolonged jaundice

A 
Breastfeeding
Biliary atresia
Congenital hypothyroidism 
Cystic fibrosis
Metabolic disorder
Neonatal hepatitis
Pyloric stenosis
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8
Q

Consequence of bilirubin deposition in different parts of the body

A

Skin and mucosa - yellow discolouration

Brain - acute bilirubin encephalopathy. Permanent damage causes kernicterus

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9
Q

Treatment of acute bilirubin encephalopathy

A

Immediate exchange transfusion

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10
Q

How do you measure bilirubin in neonates

A

Transcutaneous

Heel prick - total bilirubin, unconjugated bilirubin, conjugated bilirubin

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11
Q

Treatment of haemolytic disease of the newborn

A

Phototherapy

If rise in bilirubin >8.5micromol/L/hr with phototherapy need to give IV Ig

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12
Q

Blood tests for <24 hour neonate with jaundice

A 
FBC
CRP
Blood cultures
Blood gas - lactate
DAT
LFTs
Albumin
TFTs
Blood group
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13
Q

What percentage of conjugated bilirubin of total bilirubin requires investigation

A

> 10%

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14
Q

Stepwise treatment for neonatal jaundice

A

Hydrate - should have 4-6 hourly wet nappies
Phototherapy
Exchange transfusion

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15
Q

How do you decide the treatment required

A

Treatment threshold graph, uses:
Gestational age
Days from birth
Total bilirubin

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16
Q

Requirements before starting exchange transfusion

A

Take a detailed feeding history

High intensity phototherapy for 6 hours

17
Q

When can they be discharged

A

Once 5 small boxes below phototherapy threshold line, repeat bloods 12 hours later
If okay and no pathology suspected, can discharge

18
Q

Signs of biliary atresia

A

Pale stool
Bilious vomiting
Conjugated bilirubinaemia

19
Q

Signs of kernicterus

A 
Sleepy
Poor suck
Setting sun lid retraction
Cerebral palsy
Odd movements
Deafness
Low IQ

Paeds (27 decks)

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