Neonatology cont Flashcards
causes of jaundice <24hours
- haemolysis
- ABO/Rhesus incompatibility
- G6PD/Hereditary spherocytosis
- sepsis
causes of jaundice 24hours–>2 weeks
- physiological/ breast milk
- haemolysis
- sepsis
Ix of early jaundice?
- FBC
- blood group
- Coombs Test
- G6PD assay
- blood film
- urine sample
- blood culture
- TORCH screen
causes of jaundice >2weeks (aka prolonged jaundice)?
- Unconjugated
- breast milk
- neonatal hypothyroidism
- Conjugated
- neonatal hepatitis
- extra-hepatic obstruction ie biliary atresia
Ix for prolonged jaundice?
- TFT
- LFT
- Split bilirubin
what occurs physiologically AFTER the first day of life and why?
physiological to have unconjugated jaundice after the first day of life
- infants have a shorter RBC life span
- also have relative polycythaemia
give another cause of unconjugated infant jaundice
Gilbert’s Disease - common
Mx of unconjugated jaundice?
- Light Phototherapy
- this converts unconjugated billirubin into water soluble pigment
- Exchange transfusion if keeps rising
what should you always do in neonates who have conjugated jaundice? why is this done?
ALWAYS investigate as will always be pathological
-mainly to diagnose biliary atresia early
main causes of biliary obstruction?
- biliary atresia
- coledochal cyst
- Alagille syndrome
investigations of extra hepatic obstruction ?
- split billirubin
- observe stools
- USS
- liver biopsy
features of alagille syndrome?
- intra-hepatic cholestasis
- dysmorphism
- congenital heart disease
causes of neonatal hepatitis?
- viral hepatitis
- alpha-1-antitrypsin deficiency
Complication of jaundice?
kernicterus
aetiology of kernictus
- unconjugated billirubin is fat soluble so crosses BBB
- is neurotoxic and deposits in brain
what can kernicterus go on to cause in short & long term?
- short term- encephalitis
- lethargy
- seizures
- poor feeding
- long term
- cerebral palsy
- sensorineural deafness
what is hypoglycaemia in a newborn? ie blood glucose level
< 2.5 mmol/L
presentation of neonatal hypoglycaemia?
jitteriness, poor feeding, irritability, drowsiness, apnoea, seizures
Mx of neonatal hypoglycaemia?
- early & frequent milk feeds
- IV dextrose
risk factors for aquirinig sepsis?
- prematurity
- PROM
- maternal carriage of GBS
aetiology of neonatal sepsis?
- GBS
- E.Coli
- Staph
- H.influenzae
- Listeria monocytogenes
Clinical features of sepsis?
- respiratory distress
- apnoea
- poor feeding
- fever
- jaundice
Mx of sepsis?
sepsis 6 + urine MC&S
