Neonatal jaundice Flashcards
What is jaundice?
Accumulation of bilirubin in the skin and mucus membranes leading to yellowing of skin and sclera.
Why is jaundice especially alarming in children?
Due to kernicterus
What is Kernicterus?
Bilirubin encephalopathy caused by Bilirubin crossing blood brain barrier and depositing in basal ganglia leading to cerebral palsy, gaze abnormalities and sensorineural hearing loss.
What are the causes of unconjugated jaundice?
- Physiological jaundice
- Increased RBC breakdown
- Immature liver
- Dehydration
- Haemolytic disease (Rhesus/ABO)
- Sepsis
- G6PD deficiency
What are the causes of conjugated bilirubin?
- Biliary atresia
- CF
- Alpha-1-anti-trypsin deficiency
- Hypothyroidism
- Metabolic disorders
- Perinatal asphyxia
Can jaundice within the first 24 hours ever be physiological?
NO - Always pathological if present within 24 hours!
Physiological jaundice takes some time to develop.
What is important to know in the history of neonatal jaundice?
- Birth Hx
- Date and time of birth, gestation, birth weight, maternal blood group
- Risk factors for early onset sepsis
- PROM > 48 hours, maternal infection
- Feeding
- Method, volumes, wet nappies & stool colour
- Weight loss & gain
- Family Hx
What are key points of the examination of a jaundiced neonate?
- Colour - Check sclera and blanch skin
- Fluid status - Skin turgor, mucus membranes
- Neurological status
What are the most important investigations for a jaundiced neonate?
Always
- Transcutaneous bilirubinometer
- Serum bilirubin
Consider:
- DCT
- Sepsis screen
- U&Es
- LFTs
How do you manage neonatal jaundice?
- Feeding support (for poor feeding, dehydration & weight loss)
- Phototherapy
- IVIG
- Exchange transfusion
- Simultaneous exchange of babies blood with donor blood
How does phototherapy work?
Transforms bilirubin into water soluble isomers that can be eliminated without conjugation.
How does IVIG work?
Can prevent further red cell breakdown
What is prolonged jaundice?
> 14 days in term infants
> 21 days in pre-term infants
What investigations are indicated in prolonged jaundice (and why)?
- Split bilirubin (Rule out conjugated jaundice)
- LFTs (Rule out derangement)
- DBC & DCT (Rule out haemolysis)
- TFTs (Rule out hypothyroid)
- Urine culture (Rule out UTI)
