Newborn Jaundice Flashcards
How common in neonatal jaundice?
Common in newborns
Most are physiological and self-limiting
Minority are pathological
More common in male and east Asian infants.
What are the common cause of newborn jaundice <24hrs?
Haemolytic disorders (rhesus, G6PD deficiency)
Congenital infections - TORCH screen indicated
Sepsis
What are the typical causes of jaundice in newborns within 24hrs to 14 days?
Physiological jaundice
Breast milk jaundice
Dehydration
Infections, including sepsis
Haemolysis
Bruising
Crigler-Najjar syndrome
What can cause newborn jaundice past 14 days or 21 days if preterm?
Physiologic jaundice
Breast milk jaundice
Infection
Hypothyroidism
Biliary obstruction (including biliary atresia)
Neonatal hepatitis
What are the common causes of physiological jaundice in newborns?
Relative polycythaemia
Shorter rbc lifespans thatn in adults
Less efficient hepatic bilirubin metabolism in the first few days of life
What are the key points of managing neonatal jaundice?
If <24hrs, >7d or <35w gestations admit urgently
Increase fluid intake
May need phototherapy (monitor be every 24hrs) and transfusion
What are some complications of phototherapy in newborns?
Loose stools
Dehydration
What is the relationship between hepatitis B and pregnancy?
All pregnant women are screened for hep B.
Babies born to positive mothers should receive complete course of vaccination and hepatitis B immunoglobulin on birth.
Some evidence for lamivudine (oral anti-retroviral in latter pregnant)
Can NOT be transmitted via breastfeeding.
Risk of vertical transmission to baby
What results when Hepatitis B testing indicate for the mother?
Positive HBsAg and postiive anti-HBc IgM = acute infections
Positive HBsAg and negative HBc IgM but pos HBcIgG = chronic infection
What is the management for hepatitis of the newborn for the mother?
Pregnant women offered tenofovir disoproxil in thrid trimester onwards if load >10^7
Stopped 4-12w post partum
Can be taken during breastfeading.
What is the treatment for the child with neonatal hepatitis risk?
- Reduce chance of vertical transmission with HBV IgG and HBV vaccination within 24hrs delivery
- Vaccination at 4w, 8w, 12w, 16w and 1yr.
- HBV serology testing at 12 months.
What is the treatment for newborn hepatitis for children who are not at an increase risk?
Vaccination as poart of 6 in one vaccine at 8,12 and 16 weeks
What are the key signs/symptoms of neonatal hepatitis?
Acute - nausea, vomiting, abdo pain, lethargy and jaundice
Hepatosplenoegaly
Liver transaminases are usually elevated
Normal coagulation
