Paediatrics/ Jaundice and Hyperbilirubinemia

Question 1

What is jaundice?

Answer 1

Yellowed skin and sclera secondary to increased levels of bilirubin

Question 2

Where on the body can you first note jaundice and how does it the progress?

Answer 2

It starts in the gums and sclera, then progresses cephalocaudally. As bilirubin decreases, the jaundice recedes in the opposite direction.ay

Question 3

Jaundice appears as a physical sign when bilirubin levels reach what approximate concentration?

Answer 3

5 mg/dL

Question 4

What percent of term newborn infants have jaundice sometime during the first week of life?

Answer 4

60%

Question 5

What percentage of premature newborns have jaundice during the first week of life?

Answer 5

80%

Question 6

Why is jaundice appearing within the first day of life so worrisome?

Answer 6

It is always pathologic

Question 7

What is the differential diagnosis of jaundice on the first day of life?

Answer 7

• Erythroblastosis fetalis
• concealed hemorrhage
• sepsis
• intrauterine infection (eg, toxoplasmosis, rubella, cytomegalovirus [CMV], syphilis)

Question 8

Describe physiologic jaundice of the newborn.

Answer 8

Breakdown of fetal RBCs + immature liver’s inability to conjugate hemoglobin efficiently = jaundice secondary to rise in bilirubin

Question 9

When does physiologic jaundice peak?

Answer 9

Second to fourth day of life

Question 10

When does physiologic jaundice resolve?

Answer 10

Between fifth and seventh day

Question 11

What clues might suggest that a newborn’s jaundice is not physiologic?

Answer 11

• Appears in the first 24-36 hours of life
  
  • bilirubin rises at >5 mg/dL per day
  • total is >12 mg/dL
  • jaundice lasts more than 10-14 days
  • conjugated bilirubin level is >1 mg/dL at any time (for some labs, it must also be >20% of the total bilirubin)

Question 12

What is the fatal complication of hyperbilirubinemia?

Answer 12

Kernicterus

Question 13

What is kernicterus?

Answer 13

Brain damage from unbound, unconjugated bilirubin crossing the blood brain barrier. It results in apoptosis and necrosis.

Question 14

Which is neurotoxic, conjugated, or unconjugated bilirubin?

Answer 14

Unconjugated

Question 15

At what level of total unconjugated bilirubin do you initiate treatment?

Answer 15

Depends on the newborn’s age and risk factors, though generally between 11 mg/dL and 20 mg/dL

Question 16

How is hyperbilirubinaemia treated?

Answer 16

• Phototherapy
• the level at which is done is when uncojugated bilirubin is between 11 mg/dL and 20 mg/dL - depending on newborn’s age and risk factors

Question 17

How does phototherapy work?

Answer 17

“Bili lights” are at a wavelength that converts bilirubin into a photoisomer that the body has an easier time excreting.

Question 18

Breast-feeding failure jaundice is …

Answer 18

This is an exaggeration of physiologic jaundice. It peaks within the first few days of life, is due to poor initial milk production and increased enterohepatic circulation, and is treated by increasing breast milk feedings.

Question 19

Breast milk jaundice

Answer 19

It starts at 3-5 days, peaks at 2 weeks, and may be due to intrinsic factors in breast milk which increase the enterohepatic circulation.