Neonatal Jaundice
Physiological jaundice occurs when, at birth, the baby undergoes a period where huge amounts of HbF is destroyed, and lots of HbA (adult) is produced. This normal process of breakdown creates a rise in bilirubin and mild jaundice. It occurs from 2-7 days, and usually resolves within 10 days.
Pathological jaundice occurs in the first 24 hours of life. It needs to be investigated urgently for neonatal sepsis as it’s a common cause.
Prolonged jaundice is defined as jaundice that lasts >14 days (> 21 days if preterm). It needs to be investigated urgently for biliary atresia, hypothyroidism, and G6PD deficiency.
Raised Bilirubin
Investigations
FBC and Blood film – Polycythaemia, Thrombocytopenia, Anaemia
Blood group and Rhesus status of mother and baby
DAT/Coombs test – For haemolysis
LFTs
TFTs
G6PD levels
Blood and Urine culture – Suspected neonatal sepsis
Management:
Treatment is decided by the level of total bilirubin. This is monitored on a treatment threshold chart, with the baby’s age against the total bilirubin level. If the level reaches the threshold, treatment is started.
The main treatment option is Phototherapy. This breaks down bilirubin into excretable components, which don’t require the liver to do anything.
If bilirubin levels are extremely high, the baby may need an exchange transfusion.
Kernicterus
This is where there's severe complication of permanent brain damage due to excessive (unconjugated) bilirubin levels. This happens because bilirubin can cross through the leaky BBB in neonates. This can lead to other complications, such as Cerebral palsy, LD, and Deafness.
It presents with:
Less responsive
Floppy
More sleepy
Poor feeding
N.B. Only unconjugated bilirubin can cross the BBB as it’s lipid-soluble.