Neonatal Jaundice

Question 1

What are 3 causes of early (<48hr) jaundice?

Answer 1

1) Prematurity
2) Low birth weight
3) Red cell isoimmunisation
4) G6PD deficiency

Question 2

What are 3 causes of jaundice in 3-7days of life?

Answer 2

1) Physiological jaundice
2) Inadequate feeding
3) Prematurity and low birth weight

Question 3

Why is sufficient so important in reducing jaundice?

Answer 3

↑Stool transit → ↓Enterohepatic recirculation of bilirubin

Question 4

What are 2 causes of prolonged unconjugated jaundice (>2wks)?

Answer 4

1) Breast milk jaundice
2) Prematurity and low birth weight

Question 5

Can day 1 jaundice by physiologal?

Answer 5

NO, should only occur after a few feeds (accumulation)

Question 6

What are 4 causes of conjugated jaundice >2wks?

Answer 6

1) HPB disease (eg. hepatitis, biliary atresia, choledochal cyst)
2) Congenital hypothyroidism
3) IEMs
4) Other infections

Question 7

What are 3 causes of jaundice in a sick/unstable baby?

Answer 7

1) Sepsis
2) Dehydration
3) IEMs

Question 8

In which demographic is Rh- most common?

Answer 8

Indian and Caucasian > Chinese and Malay

Question 9

In which race of babies does serum bilirubin rise faster and for longer?

Answer 9

Chiense

Question 10

What is the pathophysiology of hemolysis of newborns RBC in ABO incompatibility?

Answer 10

O+ Mom + A/B+ Baby
Transplacental transfer of anti-A/B IgG to baby → hemolysis of baby’s RBC

Question 11

What is the most common cause of jaundice in the 1st week of life?

Answer 11

Physiological jaundice

Question 12

When is physiological jaundice expected to start and resolve?

Answer 12

2nd-10days
- unless preterm then longer

Question 13

Is physiological jaundice self-limiting?

Answer 13

Yes, no need to treat if baby is well otherwise

Question 14

What are 5 features suspicious of non-physiological jaundice?

Answer 14

1) Onset <24hrs of life
2) Rapid rise in bilirubin >100umol/day
3) Severe jaundice (palms and soles stained)
4) Unwell infant
5) Pallor
6) Jaundice lasting >2wks
7) Hepatosplenomegaly
8) Dark urine, pale stools

Question 15

What are 4 important features of a NNJ Hx that need to be elicited

Answer 15

1) Gestational age, birth weight
2) G6PD, Blood group
3) FHx
4) Progression, age, feeding
5) Stool and urine colour
6) Illness?

Question 16

Which direction does jaundice progress in a baby?

Answer 16

Cephalocaudally

Question 17

How is jaundice estimated clinically in babies?

Answer 17

Transcutaneous bilirubinometry (TCB)
- then if >90th percentile → serum bilirubin

Question 18

What are 4 components in a physical exam that are critical in a jaundiced baby?

Answer 18

1) Weight (+% change from birth)
2) Severity of jaundice
3) Dehydration
4) Encephalopathy
5) Sepsis
6) Pallor
7) Hepatosplenomegaly

Question 19

What is breastfeeding jaundice?

Answer 19

Suboptimal intake → low calorie → ↓stool output → ↑enterohepatic circulation (peaks ~3-5days) → Unconjugated hyper bilirubinemia

Question 20

How is breastfeeding jaundice managed?

Answer 20

1) More feeding (may need formula temporarily)
2) Phototherapy

Question 21

How can breastfeeding jaundice be prevented?

Answer 21

1) Educate mothers
2) Check bilirubin at least once prior to discharge
3) Outpatient follow-up ~2days after discharge

Question 22

How would one investigate for hemolysis as a cause of jaundice?

Answer 22

FBC (Hb, Retics)
PBF
Direct Coomb’s test

Question 23

What are 4 RFs of bilirubin encephalopathy (kernicterus)?

Answer 23

1) Prematurity
2) Low birth weight
3) Early onset jaundice <48hrs
4) Hemolysis
5) High serum bilirubin
6) Illness (sepsis, acidosis, dehydration)