Jaundice in newborns

Question 1

Physiological Jaundice

Answer 1

** Neveron the first day
*Usually appear at 2nd -3rd day of life , disappears 5th day
* * indirect Bilirubin < 13

Question 2

Physiological Jaundice Why it happened ? and its Treatment

Answer 2

• immature uridine glucuronosyltransferase - short RBC life time (70 days)
• Marked physiological RBCs breakdown

***Treatment
: majority require no Treatment [monitor bilirubin level]

Question 3

when we say it is Pathological Jaundice ?

Answer 3

1- Appears on 1st day of life
2- Bilirubin > 13 mg/dl
3- Rate of rise Direct bilirubin > 5 mg/dl in day or > 0.5 mg/dl in
hour.

Question 4

Pathological Jaundice Treatment:

Answer 4

** Direct Hyperbilirubinemia → Treat the underlying cause
**- Indirect Hyperbilirubinemia [ Phenobarbital (AE: respiratory depression and has no antidote), Phototherapy ]

Question 5

Phototherapy Complications

Answer 5

• Loose Stool
• Rash: Erythematous macular Rash
• Overheating can lead to Dehydration

Question 6

Breastmilk Jaundice

Answer 6

• Occurs due to the presence of glucuronidase in breastmilk
• Develop in 2nd week of life , Solved by 2- 3 months of life.
• Kernicterus may develop !

Question 7

Breastmilk Jaundice management

Answer 7

• Safe to continue breastfeeding

Question 8

ABO incompatibility – Jaundice

Answer 8

High indirect hyperbilirubinemia with Positive Coombs Test
* Mother with O type ; newborn with B type [However A Type also
can be in newborn]
* Remember that:
Type B have IgM that don’t Cross Placenta
Type O have IgG that cross the placenta
* Incidence: 40 -50% in the 1st pregnancy

Question 9

Diseases Screened prior to discharge of
neonate

Answer 9

1. B- thalassemia (normal RDW)
2. CAH = Congenital Adrenal Hyperplasia
3. Cystic fibrosis ( sweat chloride twice >60ml ,meconium ileus )
4. Galactosemia ( cataract ) (hypoglycemia,hyperbilirubinemia )
5. PKU
6. Hypothyroidism
   (large fontanelle
   diaphragmatic hernia
   large tongue)

Question 10

direct hyperbilirubinemia DDX:

Answer 10

*sepsis(s.agalactia,e.chol,
,listeria )
*TORCH infection (toxoplasmosis,other-listeria,variciella,parvo
rubella,CMV,HSV)
*hypothyroidism(thyroid agenesis is most congenital common cause ,panhypopituitarism (MC of secondary HTH )
*galactosemia
*cystic fibrosis(failure to thrive, KW: steatorrhea
-pancreatic exocrine
insufficiency (AKED) deficiency
sweat test DX : twice ,
-meconium ileus
*choledochal cyst
*biliary atresia(dx: US
tx: kasai procedure
definitive tx: liver transplant )
*dubin-jonson
*rotor syndrome

Question 11

indirect hyperbilirubinemia DDX

Answer 11

*RH/ABO incompatibility
*minor blood groups

Question 12

indirect hyperbilirubinemia +coombs (-) & high Hgb

Answer 12

*twin-twin transfusion syndrome
*maternal-fetal transfusion
*delayed cord
*IUGR
*infant of diabetic mother

Question 13

indirect hyperbilirubinemia +coombs (-) & normal/low Hgb

Answer 13

*spherocytosis
*elliptocytosis
*G6PD deficiency
*pyruvate kinase
*hemorrhage
*cephalohematoma bruising
*bowel obstruction
*brest feeding
*crigler-najjar(
infancy, kernicterus high bilirubin 20-50)
*gilbert syndrome (adolescence < 3mg bilirubin)

Question 14

5 s of spherocytosis

Answer 14

*spherocytosis
*spectrin (protein on RBC
*spleenoectomy
*s.pneumonia,h.influenza,salmonella,n.memeingitis (vaccins)
*mchc high
*sepsis