NEONATAL JAUNDICE
DEFINITIONS
Kernicterus | bilirubin encephalopathy; deposition of unconjugated bilirubin in the brain
(especially basal ganglia and brainstem) causing encephalopathy
Classical Presentation | lethargy/decreased LoC + poor feeding + hypotonia + jaundice
FEATURES: HEPATIC
DYSFUNCTION
Jaundice
Epistaxis
Encephalopathy
CAUSES OF JAUNDICE
Hypotonia
< 24h Old
> 24h Old
Persistent
Peripheral
Neuropathy
Sepsis
Sepsis
Hypothyroidism
Rickets
(vit D deficiency)
TORCH
HDN
G6PD, HS
Physiologic
Biliary Atresia
Breastfeeding
α1-Antitrypsin
Deficiency
Breast Milk
Galactosemia
Crigler-Najjar
CF
MANAGEMENT
ABC
Phototherapy
Exchange
Transfusion
IVIG
Other
• Secure ABCs
• Large bore IV cannulation
• Senior help
• Monitor Temperature
• IV Fluid Management + Urine Output
• Daily Weights
• Eye Protection
• 6hrly bilirubin monitoring
• Significant unconjugated hyperbilirubinaemia
• HDN
• Severe Anemia
• Adjunct to phototherapy in HDN or rapidly ↑ bilirubin
• Encourage breastfeeding
• Do not give additional fluids if breastfeeding
• Encourage cuddling and bonding with parents
Therapy can be stopped once bilirubin < 50µmol/L below threshold
Easy
Brusing
Petechiae
Malnutrition
Pruritis
NEWBORN SCREENING
(8 DISORDERS)
Cystic Fibrosis
Congenital Hypothyroidism
Phenylketonuria (PKU)
Galactosemia
Glutaric Aciduria Type 1 (GA1)
MCADD
Homocysteinuria (HCU)
Maple Syrup Urine Disease (MSUD)
Investigations
Blood
• FBC + PBS (anemia, infection)
• Bilirubin (incl direct & indirect)
• LFT
• TFT (hypothyroidism)
• ABO Rh (HDN)
• DAT (Coombs)
Radiological
Underlying cause of hyperbilirubinaemia and jaundice must be treated
in order to definitely resolve neonatal jaundice.
• Abdominal U/S
Other
• Newborn Blood Spot Screen
• ± TBIDA scan ± Liver Bx