Neonatal Jaundice

Question 1

What is the bilirubin pattern in physiological jaundice?

Answer 1

Unconjugated

Question 2

What is the bilirubin pattern in pathological jaundice?

Answer 2

Can be conjugated or unconjugated

Question 3

What is the timing of physiological jaundice?

Answer 3

Starts day 2-3
Peaks at day 5
Resolved by day 10

Question 4

What can cause physiological jaundice?

Answer 4

Increased red cell breakdown
- lower hb needed after birth

Immature liver

Question 5

What can cause pathological jaundice?

Answer 5

Haemolytic disease

• onset <24 hours
• previous family history
• maternal blood group

Bilirubin over phototherapy threshold

• dehydration
• increased haemolysis

Unwell neonate
- infection

Prolonged jaundice

Question 6

What is prolonged jaundice?

Answer 6

> 14 days in term infant

> 21 days in preterm infant

Question 7

What can cause prolonged jaundice?

Answer 7

Infection

Breastmilk jaundice

Metabolic cause

• hypothyroidism
• hypopituitaryism
• galactosaemia

GI cause
- biliary atresia

Question 8

What are risk factors for hyperbilirubinemia?

Answer 8

Prematurity 
Low birth weight 
Previous sibling required phototherapy 
Exclusively breast fed
Jaundice <24 hours old
Diabetic mother

Question 9

What is the clinical presentation of an infant with jaundice?

Answer 9

Yellow skin/sclera

Drowsy/not feeding well

Altered muscle tone

Poor urine put

Question 10

What investigations need to be done for jaundice?

Answer 10

Trancutaneous bilirubinometer

• > 35/40 gestation
• > 24 hours old

Serum bilirubin

• <35/40 gestation
• <24 hours old
• TCB >250

Question 11

What the management for jaundice if indicated?

Answer 11

Phototherapy

- use treatment threshold graph