Neonatal jaundice Flashcards
(40 cards)
According to NICE guidelines, what is the assessment process?
Visual inspection, checks at birth, bilirubin level measurement, risk factors for kernicterus, assessment for underlying disease
Assessment for baby under 24 hours old with suspected or obvious jaundice?
Measure and record the serum bilirubin level urgently (within 2 hours). Continue to measure the serum bilirubin level every 6 hours until the level is both: below the treatment threshold stable and/or falling.
Assessment for baby over 24 hours old with suspected or obvious jaundice?
Measure and record the bilirubin level urgently (within 6 hours
Treatment
Phototherapy (short breaks- 30 mins, daily weighing, monitor temp), exchange transfusion, intravenous immunogoblin
What is the physiology of bilirubin?
Bilirubin is mainly produced from the breakdown of red blood cells (Hb). Red cell breakdown produces unconjugated (or ‘indirect’) bilirubin, which circulates mostly bound to albumin although some is ‘free’ and hence able to enter the brain. Unconjugated bilirubin is metabolised in the liver to produce conjugated (or ‘direct’) bilirubin which then passes into the gut and is converted to urobilinogen and excreted in urine and faeces
What neonatal factors causes physiological jaundice?
Increased HB release (neonatal RBC have shorter life span than adult therefore higher turnover) (polycythaemia- haematocrit of 50-60%- more RBCs= more breakdown) Reduced bilirubin activity (liver enzyme that conjugates bilirubin is only 1% active in 1st week of life ) Increased enterohepatic circulation (increased reabsorption of bilirubin from GI tract)
What is jaundice?
Yellow colouration of the skin and sclerae caused by the accumulation of bilirubin (hyperbilirubinaemia) in the skin and mucous membranes Also in gums Physiological- 2-5 days Pathological- within 24hours of birth
What is prolonged jaundice?
Jaundice persisting beyond the first 14 days Prolonged jaundice is generally harmless, but can be an indication of serious liver disease
What causes pathological jaundice?
Production: Increased haemolysis of red cells Prematurity Decreased albumin binding capacity/Competition for albumin binding sites Lack of or reduction in enzymes and carrier proteins Lack of oxygen and glucose Hepatitis or liver damage slow the rate of transport Congenital biliary atresia Slow bowel motility
Why might there be an increased haemolysis of red blood cells and therefore increase in bilirubin production?
Rhesus isoimmunisation or ABO incompatibility RBC defects: Congenital spherocytosis (shortage of red blood cells) , G-6-PD deficiency Sepsis and /or DIC (Disseminated intravascular coagulation is a condition in which blood clots form throughout the body blocking small blood vessels) Bruising and cephalhaematoma or internal haemorrhage Polycythemia–twin to twin or materno-fetal transfusion (delayed cord clamping)–SFD infants–Infants of diabetic mothers
Why might prematurity cause jaundice?
Immaturity of the liver Low energy stores Poor feeding Lower levels of SBR will cause brain damage in preterm babies – there are specific SBR threshold charts for preterm babies
Why might there be decreased albumin capacity?
Hypoxia and acidosis Infection Prematurity Hypoglycaemia
Why might there be competition for albumin binding sites?
Free fatty acids - starvation and cold stress Drugs - sulphonamides, cephalosporins/ diazepam I.V. (Sodium benzoate)/- frusemide and other thiazide diuretics/- heparin
Why might there be a lack of or reduction in enzymes and carrier proteins?
Congenital disorders Prematurity
Why might there be a lack of oxygen and glucose?
Prolonged stress in utero or any stress in SFD infants Hypoxia at birth
Why might hepatitis or liver damage slow the rate of transport?
Metabolic disorders eg: galactosaemia Infection
What is congenital biliary atresia?
Rare congenital disorder where part of the liver draining into the bile duct is abnormally formed Early surgery can prevent liver damage so early detection is vital Late diagnosis means the baby will die without a liver transplant very rare liver disorder
Why might there be slow bowel motility?
Poor feeding Pyloric stenosis or bowel obstruction (meconium ileus, meconium plug) Congenital hypothyroidism (this is tested for on day 5)
At what point would an jaundiced baby require more investigation and possibly treatment?
Occurs within 24 hours Appears within 48 hours SBR continues to rise rapidly between days three and four Jaundice does not subside by day 5-6 Continues after 12-14 days Has abnormally high SBR Baby shows signs of being unwell
What is a physical indicator of a very jaundiced baby?
yellow hands and feet
Jaundice in 1st 24 hours?
This is always pathological Relates to causes already present at birth, usually blood incompatibility May have been predicted by rising maternal antibody levels SBR rises very rapidly and is a paediatric emergency
What happens when jaundice is caused by infection?
SBR tends to rise steadily Starts to rise related to time of infection If intrauterine infection may appear in 48 hours
What are the dangers of hyperbilirubinaemia?
In young babies, unconjugated bilirubin can penetrate the membrane that lies between the brain and the blood (the blood–brain barrier). Unconjugated bilirubin is potentially toxic to neural tissue (brain and spinal cord). Entry of unconjugated bilirubin into the brain can cause both short-term and long-term neurological dysfunction (bilirubin encephalopathy)
What are the dangers of pathological jaundice?
Bilirubin levels are generally higher than in physiological jaundice Levels remain high for longer Much higher risk of kenicterus The causes may also be harmful to the baby
