Neonatal Jaundice Flashcards
What is physiological jaundice?
Increased breakdown of foetal haemoglobin. Low capacity of fetal hepatocytes to conjugate bilirubin.
When is neonatal jaundice pathological?
Onset within 24 hours, there is conjugated hyperbilirubinaemia
What are the most important differentials if neonatal jaundice occurs within 2 days?
Early haemolysis due to ABO or Rh incompatability. Cephalohaematoma.
TORCHES infections
What are the TORCHES infections?
Toxoplasmosis, rubella, CMV, herpes and syphilis
What are the most important differentials when neonatal jaundice occurs within 3-7 days?
Usually bacterial sepsis, Crigler-Najjar or Gilbert syndromes, TORCHES infections
When jaundice starts on days 2-3, what is the most common cause?
Usually physiological, lasts <1 week
When jaundice starts after 1 week of life, what are the ddx?
Sepsis, breast-milk jaundice, biliary atresia, haemolytic anaemias (sickle cells, spherocytosis, G6PD), hypothyroidism, metabolic disorders, pyloric stenosis
What are the most important clinical questions to ask with neonatal jaundice?
Is the infant unwell? Is there dehydration/poor weight gain? Jaundice before 48 hours? Onset after 3 days? Birth hx trauma? Materal hx? FHx? Dark urine/pale stools? Level of icterus? Plethora? Hepatosplenomegaly?
How common is jaundice?
60% of full term babies, 80% of pre-term babies within the first week of life
What are we concerned about with neonatal jaundice?
Kernicterus - rare complication of unconjugated bilirubinaemia that can lead to long-term neurological sequalae
What are direct and indirect bilirubin?
Indirect = unconjugated Direct = conjugated
What fracture of total bilirubin is typically unconjugated?
> 85%
How do you work-up the neonate with jaundice?
1) Baby well or unwell
2) Is the conjugated bili >15%
3) Is there evidence of haemolysis?
4) Is the total bili or unconjugated bili in the treatable range?
5) Does the baby have prolonged jaundice (>2 week term baby, >3 weeks prem)?
If the answer to all 5 questions is no - physiological jaundice is most likely.
What are suitable discharge instructions for a child with physiological jaundice going home?
Sunlight is not recommended. Arrange early follow-up with GP/MCHN, re-check bili in 24-48 hours if borderline/still rising.
Represent if: stools pale/urine dark, unwell baby, feeding poorly, jaundice prolonged (> 2-3 weeks)
What are the causes of conjugated hyperbilirubinaemia?
Biliary atresia, choledochal cyst, neonatal hepatitis, metabolic causes (fructose intoleranace, galactosaemia), complication of TPN (in inpatients)
