Newborn Jaundice Flashcards
Physiological types of Jaundice
Physiological - High [RBC] and shorter T1/2 and slower metabolism. Day 2-4 of life and resolves by 1-2wks
Breast milk Jaundice - 5-7 days after birth and peaks by 14days 10% still jaundice at 1 month
Pathological causes of if less then 24hr
Medical emergency
Haemolysis - Rhesus disease, ABO incompatibility, RBC enzyme defect
Sepsis eg acute or intruterine infection
Rarer - RBC membrane defect eg hereditary spherocytosis
pathological causes of jaundice if 24hrs to 10 days
Most commonly benign physiological jaundice
Dehydration
Sepsis
Haemolysis
Polycythemia
Breakdown of extravasated blood eg bruising
Increased enterohepatic circulation which may be due to gut obstruction
Metabolic disease including galactosaemia
Pathological causes of jaundice that occurs past 10days old
Sepsis Hypothyroidism Hypopituitarism Hypoadrenalism Haemolytic anaemia Hereditary spherocytosis Pyloric stenosis or GI obstruction Breast milk jaundice
Risk factors for developing Jaundice
Gestationa age < 38 wk
Sibling with neonatal jaundice who required phototherapy
Mother’s intention to breastfeed exclusively
Visible jaundice in the first 24hrs following birth
Assessment of a newborn with Jaundice
FmHx of haemolysis Feeding since birth wt Hydration RF Preterm birth Onset of jaundice <24 Sepsis Asphyxia Acidosis Signs of illness lethargy Poor feeding Fever instability Vomiting significant wt loss Irritability Dark urine and light stools Bilirubin using more than 8.5micro mol/L per hr Jaundice reappearing Jaundice persisting after 2wks in term or 3 wks in preterm
Management for Jaundice in a newborn
Ix - Total serum bilirubin, FBC with film, blood group material and baby, Reticulocyte, TFT DAT and NBST
Mx - Phototherapy or exchange transfusion if passing the threshold on the graph.
Special care nursery
Fluid management
Treat underlying cause
Cx of jaundice
Bilirubin Encephalopathy or Kernicterus
Stage 1 - Lethargy, Hypotonia and poor suck
Stage 2 - that progresses to hypertonia,
Stage 3 - high pitched cry and eventually seizure and coma, hearing and visual loss
