Jaundice

Question 1

What is jaundice?

Answer 1

Yellow color of the skin and sclerae caused by bilirubin deposits.

Question 2

When is jaundice visible in adults?

Answer 2

Sclera bilirubin level > 2 mg/dL.

Question 3

When is jaundice visible in newborn skin?

Answer 3

When bilirubin level > 5 mg/dL.

Question 4

What percentage of term neonates have jaundice?

Answer 4

60% of term neonates.

Question 5

What percentage of preterm neonates have jaundice?

Answer 5

80% of preterm neonates.

Question 6

What is unconjugated bilirubin?

Answer 6

Also known as indirect bilirubin, it binds to albumin, is fat-soluble, crosses the blood-brain barrier, and is toxic at high levels.

Question 7

What is conjugated bilirubin?

Answer 7

Also known as direct bilirubin, it is water-soluble, excreted in urine and stool, and non-toxic.

Question 8

What causes increased bilirubin load in newborns?

Answer 8

High hemoglobin concentration, hemolysis, cephalhematoma or bruising, and polycythemia.

Question 9

What leads to decreased bilirubin conjugation in the liver?

Answer 9

Low uridine glucuronyl transferase activity and Glucuronyl Transferase Deficiency Type 1 (Crigler-Najjar Syndrome).

Question 10

What are the two main types of jaundice in neonates?

Answer 10

Physiological and pathological jaundice.

Question 11

When does physiological jaundice appear?

Answer 11

After 24 hours of age.

Question 12

Why does physiological jaundice develop in neonates?

Answer 12

Due to increased bilirubin load, defective bilirubin conjugation, and increased enterohepatic circulation.

Question 13

When does pathological jaundice appear?

Answer 13

Within the first 24 hours of age.

Question 14

What are signs of pathological jaundice?

Answer 14

Jaundice within the first 24 hours, rapid bilirubin increase, jaundice lasting more than 14 days, pale stools, dark urine, and direct bilirubin > 30 mmol/L.

Question 15

What is breast milk jaundice?

Answer 15

Prolonged jaundice in term infants caused by increased enterohepatic circulation of bilirubin.

Question 16

When does bilirubin peak in breast milk jaundice?

Answer 16

Bilirubin peaks at 10-15 days of age.

Question 17

What are common causes of neonatal jaundice?

Answer 17

Physiological jaundice, blood group incompatibility, G6PD deficiency, breast milk jaundice, cephalhematoma, and infections.

Question 18

What are the two types of hyperbilirubinemia?

Answer 18

Unconjugated (indirect) hyperbilirubinemia and conjugated (direct) hyperbilirubinemia.

Question 19

What is Crigler-Najjar syndrome type I?

Answer 19

A rare, severe form of hyperbilirubinemia with complete absence of UDPGT, requiring liver transplantation as the only definitive treatment.

Question 20

How does ABO incompatibility cause jaundice?

Answer 20

Type O mothers may have IgG antibodies that cross the placenta, causing hemolytic disease in babies with blood type A or B.

Question 21

What is Rh isoimmunization?

Answer 21

Hemolytic disease in newborns caused by Rh incompatibility between mother and baby.

Question 22

What is jaundice in G6PD-deficient infants associated with?

Answer 22

Lower serum conjugated bilirubin fractions and potential, though uncommon, severe hemolytic attacks.

Question 23

What are TORCH infections, and why are they relevant in neonatal jaundice?

Answer 23

TORCH (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, herpes) infections can lead to jaundice due to liver involvement.

Question 24

What are the risk factors for jaundice?

Answer 24

Early jaundice, family history of neonatal jaundice, unrecognized hemolysis, poor nursing, G6PD deficiency, and infections.

Question 25

What is kernicterus?

Answer 25

A severe condition caused by high bilirubin levels leading to bilirubin encephalopathy.

Question 26

What are the signs of acute bilirubin encephalopathy?

Answer 26

Lethargy, poor sucking, retrocollis, opisthotonos, and convulsions.

Question 27

What are the major clinical features of chronic bilirubin encephalopathy?

Answer 27

Athetosis, upward gaze, sensorineural hearing loss, and intellectual deficits.

Question 28

What is the bilirubin level associated with jaundice on the face?

Answer 28

102 mmol/L.

Question 29

What bilirubin level indicates jaundice on the lower trunk and thighs?

Answer 29

204 mmol/L.

Question 30

What are the typical management steps for a jaundiced newborn?

Answer 30

Assess birth weight, gestational age, clinical condition, classify jaundice type, and check for kernicterus.

Question 31

What is the recommended distance for phototherapy light?

Answer 31

Approximately 45 cm, but closer if necessary without overheating the baby.

Question 32

Why should phototherapy devices be kept clean and dust-free?

Answer 32

Dust can carry bacteria and reduce the effectiveness of the light.

Question 33

What supportive care is given during phototherapy?

Answer 33

Shielding eyes, keeping the baby naked, maintaining close light source distance, and regular feeding.

Question 34

What is the function of phototherapy in neonatal jaundice?

Answer 34

Phototherapy helps break down bilirubin into a form that can be excreted by the body.

Question 35

What bilirubin level typically necessitates stopping phototherapy?

Answer 35

When bilirubin levels are 50 micromol/L below the phototherapy threshold.

Question 36

What lab tests are essential for diagnosing jaundice?

Answer 36

Total and direct bilirubin, blood group and Rh, hematocrit, retic count, G6PD assay, Coomb’s test, sepsis screen, liver and thyroid function tests.

Question 37

What should be done if a newborn with jaundice is unable to feed?

Answer 37

Consider immediate exchange transfusion if phototherapy alone is insufficient.

Question 38

What is phenobarbital used for in Crigler-Najjar syndrome type II?

Answer 38

It dramatically reduces bilirubin levels, helping confirm the diagnosis.