Paeds: Neonatal Jaundice Flashcards
What to ask about in HPC in neonatal jaundice?
1) Site
2) Onset –> determine if <24h after birth or >24h
3) Progression
4) Stools –> paler?
5) Urine –> darker?
6) Feeding –> bottle/breastfed, change in appetite
7) Associated symptoms –> lethargy, recent travel, rash, fever
What is important to cover in PMH in neonatal jaundice?
1) Pregnancy & complications e.g. exposure to TORCH infections
2) Medical input after birth
3) Hospital admissions since birth
4) Diagnosed with any conditions
5) Developmental milestones
6) Vaccinations
What is important to cover in SH in neonatal jaundice?
1) Who’s at home?
2) Anyone else at home been ill?
3) Social services input
4) Parental smoking & drugs
What are some differentials for neonatal jaundice?
1) Blood group incompatibility (<24h after birth)
2) Hypothyroidism
3) Physiological e.g. breastfeeding
4) Biliary atresia
5) Infective causes e.g. viral hepatitis
6) G6PD deficiency
7) UTI
8) Prematurity
9) Congenital infections e.g. CMV, toxoplasmosis
Initial exams & assessment in neonatal jaundice?
1) Abdo exam
2) Paediatric growth chart assessment
What bloods would you want in neonatal jaundice?
1) FBC
2) LFTs
3) Serum bilirubin (conjugated & unconjugated)
4) Coagulation screen
5) Viral hepatitis screen
6) Serum A1AT
7) Coomb’s test
8) TFTs
What imaging would you want in neonatal jaundice?
Abdo US
What 2 special tests would you want in neonatal jaundice?
1) Chloride sweat test
2) Liver biopsy
How is growth affected in biliary atresia?
Can cause failure to thrive (drop in centiles)
Define prolonged neonatal jaundice
After 14 days
What is biliary atresia?
Involves either obliteration or discontinuity within the extrahepatic biliary system, which results in an obstruction in the flow of bile.
This results in a neonatal presentation of cholestasis in the first few weeks of life.
Typical presentation of biliary atresia?
1) Jaundice extending beyond the physiological two weeks
2) Dark urine and pale stools
3) Appetite and growth disturbance, however, may be normal in some cases
Typical signs in biliary atresia?
1) Jaundice
2) Hepatomegaly with splenomegaly
3) Abnormal growth
4) Cardiac murmurs if associated cardiac abnormalities present
Serum bilirubin levels in biliary atresia?
Total bilirubin may be normal, whereas CONJUGATED bilirubin is abnormally high.
Is conjugated or unconjugated bilirubin high in biliary atresia?
Conjugated
