Neonatal Jaundice

Question 1

At what level of bilirubin is jaundice visible from?

Answer 1

> 85 µmol/L

Question 2

Physiological jaundice - why?

Answer 2

Liver immature and replacement of fetal Hb

Question 3

Early jaundice - when

Causes

Answer 3

onset less than 24 hours

Haemolytic disease - Rh or ABO incompatibility
Congenital infection: group B strep, TORCH

Question 4

TORCH - What does it stand for?

Answer 4

Toxoplasmosis
Rubella
CMV
HSV

Question 5

High or prolonged jaundice - Causes:

Why does breast feeding failure cause jaundice?

Answer 5

Poor feeding leads to reduced gut motility, allowing conjugated BR to revert to unconjugated and renter the blood as part of the enterohepatic circulation.

Question 6

High or prolonged jaundice - Causes:

What does breast milk jaundice mean?

Answer 6

Breast milk jaundice - an enzyme in maternal breast milk unconjugates BR, thus increasing eneterohepatic circulation

Question 7

High or prolonged jaundice - Causes:

Why does cephalohaematoma cause jaundice?
What increases the risk for this?

Answer 7

Cephalohematoma - cranial haematomadue to birth trauma , forming pool of blood which eventually breaks down leading to increased haemolysis.

Instrumentatal delivery

Question 8

High or prolonged jaundice - Causes:

Why does bilary atresia cause jaundice?

How does it present?

What can it lead to?

How should it be treated?

Answer 8

Elevated conjugated BR as its not being recycled throguh the bilary system.

Presenting with pale poo and dark pee

Leads to liver failure and death if not treated surgically

Question 9

Anything else that can cause jaundice in a neonate?

Answer 9

sepsis - usually from UTI
hypothyroidism
CF
galactosaemia

Question 10

Signs and symptoms

Answer 10

Start at head and spreads down
Spread below the umbilicus suggests non-physiological jaundice
In non-white kids, check eyes and by pressing tip of nose.

Question 11

Investigations - Basic tests - think about what you are looking for that could be contributing to the jaundice!!!!

Answer 11

Serum BR and conjugated fraction - recheck every 6-8 hours after starting phototherapy

FBC
Blood film - can show evidence of haemolysis
Reticulocyte count - increased in haemolysis
Blood group
Coombs test - positic in rhesus and ABO haemolytic anaemia

Question 12

Investigations - Further tests for prolonged jaundice

Answer 12

LFT - increased in infection
Urine culture
Reducing substance in urine - positive in galactosaemia
TFT

Question 13

Phototherapy - when to be used?

• Why do we need to do this?
• How it works?
• When to stop treatment and why?
• Side effects?

Answer 13

Admit if onset <24hrs / > 2 weeks

To prevent kernicterus

Makes BR water soluble like conjugated BR thus it can be excreted

Until BR is 50µmol/L as there could be a rebound once treatment is stopped

Eye damage - protect eyes
Hypothermia if uncovered
Dehydration - it can interfere with feeding

Question 14

Kernicterus - what is it and why is it so bad?

S+S

Long term complications

Answer 14

Unconjugated BR >360µmol/L which deposits in brain

Sleepiness
Reduced feeding 
Irritability
Seizures
Comas

Cerebral palsy
Deafness