Neonatal jaundice + Case

MARROW

Intro

Biochemistry

Basic clinicals

Why more prone to jaundice ?

more prone to sickness like spesis ...less albumin...more permeability

Clinical Assessment

Physiological jaundice

Prematurity, polycythemia, birth injuries and dehydration and poor feeding

Causes/risk factors for exaggerated physiologcial jaundice ⇒ bruinsing, cephealhematoma, poor breat feeding and dehydration, prematurity, polycythemia (prematurity and babies of GDM mothers)

Pathological jaundice and causes

Rase of rise as in the same day?

TORCH = IUGR, congentical abnormalities associated, jaundice GO close the Door ROtor!

cephalhaemotoma, dic, bruinsing, polycythemia, SAH, IVH

Drug displacing, acidosis, sepsis. hypothermia

TORCH causes early rising

Clinical approach

History

Treatment techniques for breast feeding? 1. corect PAP etc 2 drugs 3 expressed breast feeding 4 formular milk 5 iv infusion

Examination

Investigations

Management

Duble the blood in baby

See video

https://www.youtube.com/watch?v=ywFFyzjqbJQ

Discussion, treatment and other questions - Long case

Check out a video on explaining the above details and seeing the procedure

Short case - Icterus

Summary

National Guidelines

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neonatal jaundice

lectures to be downloaded

Main green lecture

Add from neontal jaundice guidelines

add from neontal guideline books

add from textbook

add from case books

add from other sources (check list in the CR book whether done all in that)

neonatal hepatitis = intra hepatic obstruction = conjucated

for jaundice must ask mother to see nappy and see pee and poo and check out the colour

the machine only detect total and direct

Direct should be more than 20% to label as conjucated or direct hyperbilirumia if total is high

bilurbin metabolism important for mcqs and clinicals so read that

70 or 90 days rbs life span

go trhough bilirubin metabolism and add important

lipid soluble but not possible to join because bound to albumin

the lesser the gestation the lesser the threshold for treatment

nice guidelines check out

tanscutenous bilirubinometers okay for screening but very expensive so n ot found in the wards but in certain private hospitals Good for quick screening...non invasive and not for real diagnositic

Jaundice for 2 weeks = persistent neonatal jaundice for preterm = persists for more than 3 weeks of life

need to read causes for persistent neonatal jaundice

exagerrated phsiologcial jaundice

juandice of prematurity

read about HDN about ABO or Rh incomatible .... read about HDN...

antepartum haemorrrahge first regancy can be affected

rate of rise within the same day must check rate of rise

not hard and fast...so phsiolgocial jaundice can be seen in day 1

iugr + abnormalities + jaundice => TORCH

conjucated hyperbilirubmia always pathological

Neonatal hepatitis syndrome => causes of this include TORCH

Atresia => causes like cysts etc

Short notes of kernicterus => physiology, how pathological, what happnes and complications, treatment, management, clinical features

no treatment so must manage neonatal jaundice before it becomes this

Can lead to hearing problems and development and cerebral palsy and poor feeding or epistomthomus posturing

Discharge => monitor => phottheraoy => lamivudin => exchange transfusion

if mother is 0 and baby is jaundice then check blood groups

if rh negative mother, we check babys blood group

For others we dont routinely check

hemolysis => hb, pcv, haptoglobulin, reticulocte count normal retic count in neonate?

FBC, HB, PCV, Bloog group if indicated , direct coombs test, retic coucnt, blood picture (causes), can also be sespsis= > ask fro crp and sepsis

connjucated => liver atitecture and bilary tract => check ultrasound bilary atresia => diagnose hida scan but still not diagnostic, PO chololangiogram nepmtaa heptatitis syndrome => intraheptatic holestatis, can do LFTs => what? TORCH screening how to investigate bilary atresia

Phothterapy => blue floresecrnt => single beam or double beam some phottherapy machines design like an incubator so receiving light from two surfaces But those days double phottherapy

indications for phottherapy

and complications for phototherapy ?

phototherapy and exchange transfusion = usually heomolytic causes for jaundice are a reason for exchange tranfusion

How is it being done?

85ml/kg in BW => we remove the blood and give cross matched blood

centra venous access done where the blood bank is available

Can cause electroyte imbalance, blood pressure etc so must ideally be done in ICU etc unbilical line can be central access...umbilical transfusion...must be first exosed to maximum amount of line....must redo sometimes

immunoglobulin can also be used for specific conditions => for immune hemolysis there is a place for immunoglobulin ...so can do to avoid exchange transfusion.. immunoglobulin can sometimes fail so must do exchange transfusion => ET should be the last resport because so much of complications But kernicterus is worse!!!!!!!

HDN read that can lead to hydrops fetalis

RH negative mother and antenatal period => serial m inoriting of anti body titers and then they monitor for hdrops and other complications HDN is gyn and obs

serum bilirubin must be repeated 4 to 6 hourly ...and then must plot serum bilirubin leves in the graph.

phottherapy line, exchange transufion line

stop treatment 5 small sqaures beeath the phototherap line => 50 micro/ml

mg/dl => micromols/L needs to be coverted to plot in the chart usually multiply it by 17

but must check rebound serum bilirbunin after 8 to 10 hours of treatment to check how much rebound is there

otherwise the blirbin is normally done 4 to 6 hours interval

and then 48 hours time to recheck clinically with serum bilirubin level

total bilirbun is used to plot always not anything else ...must plot is based on the time the blood sample was taken not the time you got the report plot with the age of the baby at the time the sample taken

per operative cholangiogram

initially the gut of a nowborn is sterile so cant be converted to stercobilirubin so it can het turned into unconjucated and then go trhough entero hepatic circulation

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