Paeds B conditions Flashcards
Why are bilirubin levels higher in neonates?
Fetal red blood cells break down more quickly, thus releasing more bilirubin.
Normally, the bilirubin is excreted via the placenta but at birth, but with placenta not present after birth. This leads to a normal rise in bilirubin shortly after birth leading to yellow skin and sclera from age 2-7. Resolves by 10 days.
What are the causes of neonatal jaundice?
Increased Production
- haemolytic disease of the newborn
- ABO incompatibility
- Haemorrhage
- Intraventricular Haemorrhage
- Cephalo-haematoma
- Polycythaemia
- Sepsis and DIC
- G6PD Deficiency
Decreased Clearance of Bilirubin
- prematurity
- breast milk jaundice
- neonatal cholestasis
- extrahepatic biliary atresia
- Gilbert Syndrome
What are complications of jaundice in premature neonates?
Kernicterus
What is haemolytic disease of the newborn?
Incompatibility between the rhesus antigen and the surface of the RBC = haemolysis
What investigations should be done for neonatal jaundice?
FBC Blood film Conjugated bilirubin Blood type testing Direct coombs test Thyroid function Blood and urine cultures G6PD levels
How should neonatal jaundice be managed?
Threshold charts
Phototherapy
Exchange transfusion
What is kernicterus ?
Brain damage caused by excessive bilirubin levels
Bilirubin can cross the blood-brain barrier, and damages the CNS.
Results in a floppy, drowsy baby with poor feeding. Damage is permanent causing cerebral palsy, learning disability and deafness
What is neonatal sepsis?
Infection in the neonatal period leading to haemodynamic compromise and end organ damage
What organisms cause sepsis?
Group B strep E Coli Listeria Klebsiella Staph aureus
What increases the risk factors of developing group B strep?
Vaginal GBS colonisation GBS sepsis in a previous baby Maternal sepsis, chorioamnionitis or fever >38 Prematurity Early rupture of membranes Prolonged rupture of membranes
What are the clinical features of neonatal sepsis?
Fever Reduced tone and activity Poor feeding Resp distress or apnoea Vomiting Tachycardia Bradycardia Hypoxia Jaundice within 24 hours Seizures Hypoglycaemia
What are the red flag symptoms of neonatal sepsis?
Confirmed or suspected sepsis in mother
Signs of shock
Seizures
Term baby needing mechanical ventilation
Resp distress starting more than 4 hours after birth
Presumed sepsis in another baby in a multiple pregnancy
How do you treat presumed neonatal sepsis?
Monitor and observe for at least 12 hours if one risk factor/ clinical feature
Two or more risk factors/clinical features then start antibiotics (benzyl pen and gent)
Blood cultures before antibiotics
Lumbar puncture
What is the ongoing management for neonatal sepsis?
Check CRP at 24 hours and check blood culture results at 36 hours
Consider stopping antibiotics if baby is clinically well and blood cultures negative after 36 hours and crp <10
Check CRP at 5 days if still on treatment
What is Down’s syndrome?
Genetic abnormality where there as been an extra copy of chromosome 21 (trisomy 21)
