Neonatology

Question 1

What are the causes of neonatal jaundice due to increased bilirubin?

Answer 1

Haemolytic disease of the new born
ABO incompatibility
Haemorrhage
Intraventricular haemorrhage
Cephalohaematoma
Sepsis + DIC
G6PD deficiency
Polycythaemia

Question 2

What are the causes of neonatal jaundice due to decreased clearance of bilirubin?

Answer 2

Prematurity
Breast milk jaundice
Neonatal cholestasis
Extrahepatic biliary atresia
Endocrine disorders
Gilbert syndrome

Question 3

What is the pathophysiology of breast milk jaundice?

Answer 3

Breast milk impairs the liver’s ability to process bilirubin
Inefficient breastfeeding > dehydration > slow stool passage > ^ bilirubin absorption

Question 4

What is the pathophysiology of haemolytic disease of the newborn?

Answer 4

Incompatibility of maternal and fetal rhesus antigens > maternal immune response mounted (sensitivity during initial pregnancy) > subsequent pregnancies anti-D Abs cross placenta and fetal immune system attacks own red blood cells > haemolytic > jaundice

Question 5

What is the criteria to diagnose prolonged jaundice?

Answer 5

More than 14 days in term babies
More than 21 days in preterm babies

Question 6

What investigations should be completed in a neonate with prolonged jaundice?

Answer 6

FBC
Conjugated bilirubin
Blood type testing
Direct Coombs testing
Thyroid testing
Blood and urine cultures
G6PD deficiency testing

Question 7

What is the management of jaundice in children?

Answer 7

Phototherapy
Exchange transfusion (in extreme levels)

Question 8

What are the complications of prolonged jaundice in the neonate and how would it present?

Answer 8

Kernicterus
=> drowsy, floppy baby, poor feeding
> cerebral palsy, learning disability, deafness