jaundice

Question 1

What is physiological jaundice and causes?

Answer 1

Occurs within 2-7 days after birth usually resolves in 10 days, mild yellowing of skin and sclera baby remains healthy and well. Common in breast fed babies.

Foetal RBC’s break down and release bilirubin and excreted through placenta. Without placenta this causes a normal rise in bilirubin causing

Question 2

What can cause prolongation of physiological jaundice?

Answer 2

• Breastmilk jaundice can prolong jaundice in breastfed babies up to 1 month.
• Biliary atresia

Question 3

What is pathological neonatal jaundice?

Answer 3

Yellowing of skin and sclera, occurs within 24 hours of birth.

Question 4

What can cause pathological neonatal jaundice?

Answer 4

• Biliary atresia
• Rhesus or ABO incompatibility
• Alpha-1-antitrypsin deficiency
• hypothyroidism

Question 5

What is it and the presentation for biliary atresia?

Answer 5

• jaundice
• dark urine
• clay coloured stools,

Px: due to obstruction in tubes that carry bile from liver to gallbladder

Question 6

What is the indication for skin prick test?

Answer 6

Skin prick testing: (can support diagnosis of cow’s milk allergy, but not necessary) used to identify any allergies

Question 7

What is the Mx for biliary atresia?

Answer 7

Surgical intervention is the only treatment

Question 8

What investigations would you carry out if suspecting biliary atresia?

Answer 8

• Serum bilirubin: conjugated bilirubin is abnormally high
• Liver function tests (LFTs) including serum bile acids and aminotransferases are usually raised but cannot differentiate between biliary atresia and other causes of neonatal jaundice
• Serum alpha 1-antitrypsin: Deficiency may be a cause of neonatal cholestasis
• Sweat chloride test: Cystic fibrosis often involves the biliary tract
• Ultrasound of the biliary tree and liver: May show distension and tract abnormalities