new born jaundice

Question 1

level of billirubin greater than 85 μmol/L is req for what?

Answer 1

CLINICALLY DETECTABLE JAUNDICE

Question 2

how often does newborn jaundice occur

Answer 2

80 % of preterm infants

60% of term infants

in first week of life up to first month

Question 3

types of hyperbilirubinemia

Answer 3

unconjugated / conjugated

physiological / patholigical

Question 4

which type of hyperbilirubinemia is toxic

Answer 4

unconjugated

causes kernicterus

Question 5

what is kernicterus

Answer 5

drain damage d/2 hyperbillirubinemia

sx: seizures, spasms, lack of upward gase musc spasm, shrill crying

rx w/ tfusion and phototherapy

Question 6

describe physiological jaundice

Answer 6

on 2nd/3rd days

lasts 7-10 days

d/2 immature liver & rbc
bkdwn

no more than 200μmol/L

Question 7

when does physiolgic jaundice exceed 200μmol/L

Answer 7

premature birth

hemolysis ( bruising)

Question 8

describe early neonatal jaundice

Answer 8

w/n 24hrs of birth

d/2

1. hemolytic diseases
   - rhesus, abo, G6PD def, minkovsky chauff
2. maternal hemolytic anemia
   - lupus,
3. infection
   - congenital/ postnatal
4. genetic defects
   - gilbert(reduced ugt), dubin johnson(def trans in liver, criglar najar( dysfunc UGT)
5. haemotoma causing hemolysis

Question 9

prolonged jaundice

Answer 9

over 14 days at term
over 21 days preterm

d/2

• infec
• hypothyroidism/Hypopituitarism
• galactosemia
• gi
• bile atresia, neonatal hepatitis,

Question 10

conjugated hyperbilirubinaemia

Answer 10

d/2
Cystic Fibrosis
GI
endocrine

Question 11

rf for newborn jaundice

Answer 11

low birth weight

breast feeding

sibling w/ history of newborn jaundice

male infants

high altitude populations

east asians

Question 12

presentation of newborn jaundice

Answer 12

pale stool dark urine suggests hepatitis(congenital infec) & bile atresia

hepatosplenomegaly, petechia, microcephaly(anemia)

Neurological signs for kernicterus:
-seizures, hypo/pertonia, shreik cry

Question 13

what are the very first signs of jaundice

Answer 13

pale face and forehead

Question 14

dg tools in newborn jaundice

Answer 14

measure bilirubin lvl

• serum billi
• in babies
• if transcut is unavailable

*transcut billirubinometer

dx dg betw hepatitis and
biliary atresia

• liver function tests
• ALP, GGT
• ALAT, ASAT

*US

hemolysis tests

• Direct coomb’s
• blood type/rh
• ez assays

Question 15

how to manage newborn jaundice

Answer 15

billirubin monitoring

rx underlying cause

increase fluid

• promote excretion
• prevent DhyD in photo

phototherapy
-maintain temp, hyD, eye & skin care

• only in unconjugated
• causes DhyD, loose stools

blood transfusion
-use umbillical artery/ vein

Question 16

management of early neonatal jaunduice/ w/in 24 hrs

Answer 16

urgent hospitilasation d/2 serious underlying pathology

Question 17

management of prolonged jaundice

14 days if gest age is 37 or over wks

21 days if gest age is under 37 wks

Answer 17

-cbc

• check congugated billirubin.
• over 25 suggests hepatic disease
• check for pale stools/ dark urine
• coomb’s test for blodo type

-

Question 18

prognosis

Answer 18

good w/ prompt rx

depends on type

bile atresia require surgery BEFORE 60 DAYS