Jaundice
·
Key question is why, not by how
much (although this is important too)
·
Two types of bilirubin:
o Unconjugated:
§ If unconjugated ® kernicterus: cerebral palsy, deafness, ¯IQ
§ Can die acutely (seizures, bilirubin encephalopathy)
§ If survive: deaf, athetoid cerebral palsy (snake like movements – the
harder they try to move the harder it becomes), normally intelligent
o Conjugated: water soluble, conjugated in liver by glucuronyl transferase
·
Early onset (in 1st 24 hours):
o Always pathological
o Causes:
§ Haemolysis of any cause (eg Rhesus, ABO blood incompatibility,
spherocytosis, G6PD deficiency etc)
§ Sepsis: respiratory distress + jaundice (not common)
o Exam:
§ Maybe hydrops fetalis, large liver, large spleen (site of haemopoesis in newborn)
§ Sepsis: especially breathing (indrawing and difficulty) – if in doubt
then culture and stat antibiotics
o Prevention:
§ Expect ABO if they‟ve had it before
§ Check for Rhesus disease
·
Jaundice in 1st week:
o Emphasis on extent of the jaundice (as well as consideration of the
cause)
o Treatment:
§ Phototherapy (visible light at the blue end of the spectrum – not UV)
§ Exchange transfusion
·
Persistent jaundice:
o If it doesn‟t got away by 10 – 14 days then revisit
o Causes:
§ Conjugated
bilirubin (go green) – needs treatment
·
Liver obstruction abnormalities
(eg biliary atresia, secondary to liver damage from infection, toxins, etc)
· Hepatitis/liver inflammation
§ Unconjugated (yellow) – needs treatment if high. Eg Breast milk jaundice
– progesterone in breast milk delays maturation
o Diseases picked up on Guthrie card causing jaundice:
§ Hypothyroidism
§ Galactosaemia
§ Cystic Fibrosis
· Aside: ABO Blood Incompatibility
o Maternal antibodies from mother with type O blood attack fetal blood cells if type A, B, or AB. Not isoimmunisation – it‟s an existing immune response. Doesn‟t get worse with subsequent pregnancies
o Transfusion:
§ Want to transfuse type O RBCs – aren‟t antigenic to anyone
§ Want to transfuse type AB plasma – won‟t contain antibodies to either
type A or B blood
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