Physiological Jaundice Flashcards
When is physiological jaundice most common?
Between day 3 and 7
Why does physiological jaundice occur?
The full term foetus usually has s greater number of red blood cells than required after birth as a consequence of the need to attract oxygen across the placenta.
At birth an increased number of red blood cells need to be broken down resulting in an orange yellow pigment in the skin.
In neonates particularly unwell or pre term they lack the enzymes required to do this.
Unconjugated bilirubin leaves blood and is stored in areas of fat such as beneath the skin.
Which pathological conditions give rise to jaundice?
Rhesus incompatibility
Abnormalities in the bile duct
Metabolic disorders
What if bilirubin levels are excessively high?
If levels of bilirubin are too high there is the risk of it binding to fatty areas of the brain particularly the basal ganglia. This was cause an irreversible condition called kernicterus which causes brain damage.
What is bilirubin?
Bilirubin is fat soluble and binds to albumin in the blood where it is transported to the liver to be conjugated (made water soluble).
What is the likelihood of neonates getting jaundice?
60% of term babies at one week of ages
80% of pre term babies at one week of age
10% of exclusively breastfed babies are still jaundice at one month of age
List the causes for concern with physiological jaundice
Jaundice in the first 24 hours from birth
History of antibodies which may cause RBC haemolysis which would have been picked up on early maternal blood screening
Any baby who remains jaundice after 14 days of age
Any baby who is visually jaundice should be checked with an SBR monitor as a visual assessment inaccurate.
List the increased risk factors for developing jaundice
Birth trauma or evident bruising (increased production of unconjugated bilirubin)
Family history of significant haemolytic disease or jaundice siblings
Maternal antibodies at booking
Prematurity
Evidence of infection
