NEONATAL JAUNDICE Flashcards
How common is neonatal jaundice in term and preterm babies? High levels of unconjugated bilirubin can cause which neurological condition?
60% term, 80% pre-term in first week
Bilirubin is neurotoxic and can cause kernicterus (deafness, athetoid cerebral palsy, seizures) if untreated
What is the main cause of neonatal jaundice? When do you expect it to peak and resolve?
Immature hepatic conjugation
But poor feeding particularly in breastfed infants can contribute
- peaks around day 3-4, usually resolves by 14 days
When is action required in neonatal jaundice?
Measure bilirubin (transcutaneous or serum): action required when SBR is above gestation gestation and age cut-offs e.g. > 300 µmol/L in term infant at 72 hours or rapidly rising
What are some causes of elevated SBR in neonatal jaundice?
- Exaggerated physiological jaundice (pre-term, bruising)
- Sepsis
- Haemolytic disorders
- Hepatic disease
What is the main treatment of neonatal jaundice? How does it work?
Bluelight phototherapy: converts bilirubin to water-soluble form that can be excreted in urine
When should you assume that neonatal jaundice is pathological? What screening should you consider in this situation? What are some causes?
If it occurs in first 24 hours: assume pathological and start phototherapy
- Consider sepsis screen/TORCH
- Haemolysis (Rh disease), G6PD deficiency, sepsis, severe bruising
What is a benign self-limiting cause of prolonged jaundice?
Breastfeeding, usually resolves by 12 weeks
Most neonatal jaundice is caused by unconjugated bilirubin. When it is caused by conjugated bilirubin what causes should you consider?
- Sepsis
- TPN
- Biliary tract obstruction e.g. biliary atresia
- Viral hepatitis
- TORCH infections
- Alpha-1 antitrypsin deficiency
- Cystic fibrosis
- Haemolytic disease
What is the coombs (DCT) test?
- Used to detect antibodies that act against surface of RBCs
- Presence indicates haemolytic anaemia
