NEONATAL JAUNDICE (nnj)

Question 1

Define Jaundice

Answer 1

Clinical sign characterized by yellow discoloration of the skin and sclerae due to the accumulation of bilirubin.
Most prevalent in pre-term infants.

Question 2

What makes neonates more prone to Jaundice?

Answer 2

High bilirubin production due to lower red blood cells life span |(70-90) , slow clearance ( hepatic glucoronyl transferase immature) and uniquely susceptible to toxicity - blood brain barrier is permeable to bilirubin for the first 10 to 14 days, cannot metabolize bilirubin to harmless urobilinogen

Question 3

Signs of acute bilirubin encephalopathy.

Answer 3

Lethargy, poor feeding, high pitched cry, seizures, Opisthotonus

Question 4

Histological and/ Clinical signs of chronic bilirubin encephalopathy.

Answer 4

Kernicterus: accumulation of bilirubin the basal ganglia. Cs: athetoid cerebral palsy, paralyses and hearing loss.
BIND: Bilirubin induced neurological dysfunction.

Question 5

Physiological jaundice

Answer 5

• Physiological
  – Elevated unconjugated
  bilirubin
  – TSB generally peaks at
  about 100umol/L on day
  3-4 and then declines to
  adult levels by day 10
• Asian infants peak at
  higher values
  – Exaggerated physiologic
  (up to 290umol/L)

Question 6

• Pathological Jaundice

Answer 6

– Any increase in
conjugated bilirubin
– Early jaundice: before 24
hours of life
– Extremely high
– Prolonged