Neonatal Jaundice - occurs in 60% of neonates
As with adults, jaundice is caused by a build up of billrubin, a pigment released in the breakdown of red blood cells and excreted (after being conjugated in the liver), mostly in faeces, but also in urine. 
Most neonatal jaundice does not need active treatment. If jaundice seen  >24 hours it is normally physiological. Jaundice <24 hours after birth is always pathological. 
Physiological Jaundice - contributing factors:
Increased bilirubin production due to shorter RBC lifespan
Decreased conjugation of bilirubin due to immature liver
Lack of bacteria in gut decreases bilirubin excretion
Pathological Jaundice with 24 hours - causes:
Sepsis
Rhesus haemolytic disease - mum has antibodies to child’s blood cells
ABO incompatibility - as with Rhesus disease
RBC anomalies - spherocytosis (shape), G6PD deficiency (enzyme)
Prolonged Jaundice - after 14 days
Sepsis - do UTI and TORCH infection screen
Breast feeding
Hypothyroidism
Biliary Atresia
Cystic Fibrosis
Kernicterus
(Icterus is another word for jaundice, but I genuinely have no clue why we even need another word.)
Encephalopathy from acute bilirubin, esp if > 360 micromol/l
Can result in deafness and low IQ in long term
Can be prevented by mangaging jaundice
Mangagement -
Phototherapy - breaks down bilirubin into soluble products
Blood Exchange Transfusion

Neonatal Jaundice - occurs in 60% of neonates

As with adults, jaundice is caused by a build up of billrubin, a pigment released in the breakdown of red blood cells and excreted (after being conjugated in the liver), mostly in faeces, but also in urine. 

Most neonatal jaundice does not need active treatment. If jaundice seen  >24 hours it is normally physiological. Jaundice <24 hours after birth is always pathological

Physiological Jaundice - contributing factors:

  • Increased bilirubin production due to shorter RBC lifespan
  • Decreased conjugation of bilirubin due to immature liver
  • Lack of bacteria in gut decreases bilirubin excretion

Pathological Jaundice with 24 hours - causes:

  • Sepsis
  • Rhesus haemolytic disease - mum has antibodies to child’s blood cells
  • ABO incompatibility - as with Rhesus disease
  • RBC anomalies - spherocytosis (shape), G6PD deficiency (enzyme)

Prolonged Jaundice - after 14 days

  • Sepsis - do UTI and TORCH infection screen
  • Breast feeding
  • Hypothyroidism
  • Biliary Atresia
  • Cystic Fibrosis

Kernicterus

(Icterus is another word for jaundice, but I genuinely have no clue why we even need another word.)

  • Encephalopathy from acute bilirubin, esp if > 360 micromol/l
  • Can result in deafness and low IQ in long term
  • Can be prevented by mangaging jaundice

Mangagement -

  • Phototherapy - breaks down bilirubin into soluble products
  • Blood Exchange Transfusion
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