paediatric jaundice

Question 1

post-natal ward, well-looking baby at 16 hours old

born at term following normal labour and vaginal delivery

has had 3 good breast feeds since birth and is well hydrated

however, mum and midwife have noticed that baby is quite jaundiced

mother is asian and blood group A rhesus -ve

she has one previous normal child who was born in rural India

(a) what is the jaundice that would be most concerning in this case?

Answer 1

haemolytic jaundice

Question 2

(b) list 4 ix which should be performed to ix jaundice in a neonate?

Answer 2

1. establish dx
   
   • transcutaneous bilirubinometer
   • split bilirubin test
2. identify cause
   
   • direct Coombs test
   • peripheral blood smear, group + save
   • G6PD test, FBC, abdo USS, liver biopsy etc.

Question 3

(c) you decide to start rx pending the results from your ix. what rx would you start and how does it work?

Answer 3

phototherapy

causes photochemical rxns that transform bilirubin to isomers that:

1. are less lipophilic and hence more easily excretable
2. produce breakdown products that do not require conjugation in the liver

Question 4

(d) list 2 possible complications of this rx

Answer 4

1. loose stools
2. skin rash
3. potential retinal damage
4. insensible water loss

Question 5

(e) what other more invasive rx option is available if your first-line therapy fails?

Answer 5

exchange transfusion

Question 6

(f) what is the most important consequence of failing to adequately treat the jaundice?

Answer 6

kernicterus

^{necrosis of neurons in brainstem, hippocampus and cerebellum ⇒ paralysis of upward gaze, SNHL, dental dysplasia, intellectual deficit and chorio-athetoid cerebral palsy}

Question 7

(e) list 2 clinical reasons why jaundice is important in the newborn?

Answer 7

1. risk of acute and/or chronic bilirubin encephalopathy (kernicterus)
2. may be the 1st indication of potentially treatable condition e.g. hypothyroidism
3. may indicate serious underlying pathology e.g. biliary atresia

Question 8

(g) which 2 particular patterns of jaundice are most clinically concerning and why?

Answer 8

1. jaundice that appears within 24 hours
2. jaundice lasting >2 weeks

both would increase the likelihood of an underlying pathological cause