neonatal jaundice Flashcards
complciation of jaundice
Kernicterus is a rare but serious complication of untreated jaundice in babies. It’s caused by excess bilirubin damaging the brain, especially by the basal ganglia. - moves into brain tissue causing damage hearing loss and cerebral palsy
serious cuase of jaundice needed to be ruled out
sepsis
UTI
serious cuase of jaundice needed to be ruled out
sepsis
UTI
normal breast milk jaundice that can be reassured
caused by what and when
normally day 2 and peaks at day 7 then regresses
caused by increased bilirubin re-uptake in the gut
if phtotherapy is started how often should you recheck bilirubin level
4-6 hours
over 250 if when you may need treatment
4-6 hours start falling and then 6-12 when levels are stable or falling - once they have fallen over 50 micromoles below treatment threshold photherapy can be stopped. then recheck bilirubin 12-18 hours to assess fro rebound hyperbilirubinaemia . if at this time levels above below 50 then no further mntioring hwoever if bilirbuin has risen to 50 below treatment then levels recked in 12 hours and consdier restartign photo
acute bilirubin encephalopathy is casued by
toxic build up of unconjugated bilirubin within CNS
lipid soluble
if high bilirubin but dosen mett criteria for treatmetn what should you do
check bilirbuin within 18hours and keep in hospital during this time
A 21 day old baby boy is brought to the GP because of yellow skin and eyes.
The yellowness started at 7 days of life and has been getting worse. The baby has been bottle fed with poor feeding. He has had 8 wet nappies of dark urine a day and has passed chalky white stools for the last week. The baby was born by spontaneous vaginal delivery at 39 weeks gestation after a normal pregnancy. He has otherwise been well, with no fever, abnormal movements or rash.
On inspection, he appears well. The abdomen is soft and the liver is palpable 2cm below the costal margin. Blood tests show a normal haemoglobin, raised ALT and ALP, and raised total bilirubin (predominantly conjugated). An abdominal ultrasound scan shows echogenic hepatic fibrosis in the liver.
Which of the following investigations will definitively diagnose the likely condition in this case?
cholangiography - over 14 days so prologned - pale stools nad dark urine and conjuagted increased bilirubin obstructive jaundice . US echogenic fibrosis suggestive of biliary atresia
physiological jaundice
jaunidce occurs as a result of increased foetal red blood cells ( high turnover) and immature liver not able to metabolise bilriubin quickly - normally present 24hr of life
within 24hr is nroamlyl pathological
Which of the following routinely tested for substances is raised in physiological jaundice?
unconjugated bilirubin
due to feoetal RBC - creatign more to break down
immature liver cannot retoblise quick enough for GI tract to excrete.
biliary atresia presentation - Biliary atresia is a rare condition where the bile ducts of an infant are progressively fibrosed and destroyed, leading to conjugated hyperbilirubinaemia, liver failure and death if not treated.
Prolonged jaundice (i.e., jaundice that persists beyond 14 days of life)
Signs of biliary obstruction (e.g, dark urine and chalky white stool)palpable mads in LUQ in 3rd-4th week of liver
findigns in BA
raised conjugated bilirubin and deranged liver function tests
A hepatic scintigraphy (technetium-99) radioisotope scan will highlight the liver (takes up the isotope) but poor excretion into the bowel (as the bile ducts connecting the liver and the gut have been destroyed)
Abdominal ultrasound reveals echogenic hepatic fibrosis
Definitive diagnosis of biliary atresia is confirmed with cholangiography, which will fail to show normal architecture of the biliary tree
MX of BA
Surgery is required: hepatoportoenterostomy (Kasai procedure), which creates a new pathway from the liver to the gut to bypass fibrosed ducts - remove blocked bile ducts and replacing them with a segement of the small bowel
other jaunidce , cric-najeur and others cause rasied levels of unconjuagted
