Neonatal Jaundice

Question 1

Icterus

Answer 1

Neonatal jaundice - yellowish pigmentation of skin and sclera

Appears when total bilirubin levels rise above the 95th percentile for age (usually greater than around 2mg/dl)

Pre hepatic
Hepatocellular
Post hepatic

Question 2

Unconjugated hyper bilirubinemia (UGHB)

Answer 2

Physiological jaundice

Total bilirubin levels are raised and conjugated bilirubin levels are normal - <1mg/dl

Common in pre term infants - gets in first 2days- 1 week of life

At birth - high haematocrit but red blood cells have a shorter life so large number of red cells get turned over - lots of Hb released and hence unconjugated bilirubin released… also newborn livers are inefficient at conjugating bilirubin and also at excreting this bilirubin into the intestinal tract - leads to unconjugated hyperbilirubinemia

Total bilirubin rises slower than 0.2 mg/dl/hr , overall levels don’t rise above 18mg/dl and resolves within 1 week or full term infants or 2 weeks in pre term infants

Question 3

Pathological jaundice

Answer 3

UGHB- In the first 24 hours after birth

Total bilirubin over 0.2 or lasts greater than 1 week for term or 2 weeks for pre term

Infant shoes signs or symptoms of a serious illness

Pre hepatic cause
Do a Coombs test

Question 4

Coombs test

Answer 4

Mothers antibodies attack baby’s RBCs due to Rhesus or ABO incompatibility

RH- mother is RH negative and father is RH positive during delivery of RH+ first baby - some baby’s RBCs can get into mothers circulation - RBCs get detected by mothers immune system and in turn - maternal anti-rhesus antibodies are generating

2nd baby- If also RH+ then pre-formed anti-RH antibodies from the prior pregnancy - can cross the placenta and destroy an infants RBCs

To prevent this - all RH- mothers given anti-rhesus antibiotics or gamma globulins At 28 weeks of gestation and again within 72 hours of post partum -

Question 5

ABO incompatibility

Answer 5

Most common - mum has O blood group and baby has A or B blood type