Neonatal jaundice

Question 1

Why is jaundice common in newborns?

Answer 1

• High Hb concentration at birth thus a marked physiological release of haemoglobin - life span of fetal haemoglobin red cell is shorter at 70 days whereas for adult its 120 - hepatic billirubin metabolism is less effective in the first few weeks of life

Question 2

What is the potential cause of jaundice <24 years of age?

Answer 2

1. Haemolytic disorders such as - Rhesus haemolytic disease - ABO incompatibility 2. Congenital infection

Question 3

What is Rhesus haemolytic disease?

Answer 3

1. Mother is Rhesus negative - RHD 2. Foetus is Rhesus positive 3. After 1 pregnancy of ‘ sensitisation’ 4. Next time a pregnant woman is exposed to Rhesus positive blood she has antibodies against Rhesus + blood 5. Anti bodies cross the placenta and cause rhesus disease in the newborn

Question 4

Jaundice 2 days to 2 weeks of age

Answer 4

1. Physiological jaundice 2. Dehydration 3. Infection 4. Polycythaemia

Question 5

Physiological jaundice

Answer 5

1. All other causes have been excluded 2. Feotus is adapting and thus there is a rise in bilirubin

Question 6

Breast milk jaundice

Answer 6

1. Unconjugated hyperbilirubimia 2. More prolonged in breast fed infants

Question 7

Dehydration

Answer 7

• jaundice is exacerbated if milk intake is poor and fetus is also dehydrated

Question 8

How is severity of jaundice ix

Answer 8

1. All babies must be clinically checked for jaundice in the first 72 hours via blanching test 2. Transcutaneous billiriubin measurement must be made

Question 9

Management of Jaundice

Answer 9

1. Assess poor milk intake or dehydration and resolve these risk factors which can increase severity of jaundice 2. Phototherapy - unconjugated billirubin is converted to harmless water soluble pigment excreted predominantly in the urine 3. Exchange transfusion - required when billirubin levels rise to a potentially dangerous level -used if phototherapy is ineffective

Question 10

Causes of jaundice > 2 weeks ( prolonged neonatal jaundice) - Unconjugated hyperbilirubaemia

Answer 10

1. Breast milk jaundice - most common cause affecting 15% of healthy breastfed humans 2. Infection - espec UTI 3. Congenital hypothyroidism - often presents with prolonged jaundice before other clinical features manifest.

Question 11

How does conjugated hyper bilirubinemia present?

Answer 11

1. Baby passes dark urine and unpigmented pale stool 2. hepatomegaly and poor weight gain may be present

Question 12

Kerticterus - define the condition

Answer 12

encephalopathy resulting from deposition of unconjugated bilirubin in the basal ganglia - occurs when levels of unconjugated bilirubin exceeds the albumin binding capacity of bilirubin in the blood

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Question 13

Clinical features of Kernicterus

Answer 13

1. Lethargy
2. Poor feeding
3. Seizures + Coma are long term effects

Question 14

What are the long term complication of kernicterus?

Answer 14

1. Choreoathetoid cerebral palsy due to damage of the basal ganglia
2. learning difficulties and sensoneural deafness