Neonatal Jaundice

Question 1

How common is neonatal jaundice and what causes it?

Answer 1

1. 60% of neonates

2. Raised bilirubin levels

Question 2

What is this describing?

Increased production of unconjugated bilirubin or failure of bilirubin conjugation in the liver. Neonate.

Answer 2

Neonatal unconjugated hyperbilirubinaemia

Question 3

What are the physiological causes of neonatal unconjugated hyperbilirubinaemia?

Answer 3

1. Excess RBC breakdown

2. Liver immaturity

Question 4

What are the pathological causes of neonatal unconjugated hyperbilirubinaemia?

Answer 4

1. ABO incompatibility
2. Rhesus haemolytic disease
3. G6PD
4. Gilbert’s, Criggler-Najar (absolute UDP deficiency)
5. PK
6. Spherocytosis, ellipsoidosis
7. CMV, herpes
8. Sepsis, UTI

Question 5

What is this describing?

Reduced excretion of bilirubin from the liver/biliary tract or chronic illness affecting the liver. Neonate.

Answer 5

Neonatal conjugated hyperbilirubinaemia

Question 6

What are the causes of neonatal conjugated hyperbilirubinaemia?

Answer 6

1. Obstruction - biliary/duodenal atresia
2. Chronic illness - CF, hypothyroidism, hypopituitarism
3. Liver disease - hepatitis A/B/C
4. Metabolic - A1AT, Dublin-Johnson syndrome

Question 7

When is neonatal jaundice pathological and when is it usually physiological?

Answer 7

1. Pathological - within 24 hours of birth

2. Physiological - >24 hours after birth

Question 8

How many neonates with jaundice will reach the threshold for phototherapy?

Answer 8

20%

Question 9

How is neonatal jaundice investigated?

Answer 9

1. Serum conjugated and unconjugated bilirubin
2. Blood group and Coomb’s test (ABO and rhesus incompatibility)
3. FBC and blood film
4. TFTs
5. Urine dip and MCS for UTI
6. U&Es, LFTs (hepatitis), liver USS (obstruction)
7. Infection screen (urine and blood cultures)

Question 10

What is the management for neonatal unconjugated hyperbilirubinaemia?

Answer 10

1. If bilirubin reaches a threshold - phototherapy (speed up bilirubin metabolism)
2. If extremely high/not decreasing - exchange transfusion (reduce haemolysis)

Question 11

What is the management for neonatal conjugated hyperbilirubinaemia?

Answer 11

1. Rule out obstruction with abdominal USS.

2. Duodenal atresia requires surgical intervention.

Question 12

When is neonatal jaundice considered prolonged?

Answer 12

If it is not fading after 14 days in term/21 days in preterm.

Question 13

What are the causes of prolonged neonatal jaundice?

Answer 13

Biliary atresia, hypothyroidism, galactosaemia, UTI breast milk jaundice.

Question 14

What is the major complication of neonatal jaundice?

Answer 14

If untreated - kernicterus (bilirubin encephalopathy)

1. Seizures, lethargy, high-pitched cry, fever.
2. Caused by accumulation in basal ganglia.
3. Can lead to deafness and cerebral palsy.