34 Questions
What is the normal serum bilirubin level in newborns?
2-3mg/dL
What percentage of term newborns develop jaundice in the 1st week of life?
60%
What is the arbitrary bilirubin index commonly used in clinical practice?
20mg/dL
What is the assumed mechanism by which bilirubin is toxic to cells?
It damages neurons when it exceeds binding sites on albumin
What is the indication for double volume Exchange Blood Transfusion (EBT)?
Severe hyperbilirubinemia
What is the dwell time for blood exchange during EBT?
2-3 minutes
What is the purpose of giving 1ml of Calcium gluconate after every 100mls of blood exchanged during EBT?
To prevent hypocalcemia
What is a potential complication of EBT related to blood transfusion?
All of the above
What is a contraindication for Exchange Blood Transfusion (EBT)?
Cardiopulmonary instability
What is the purpose of using protoporphyins in the treatment of neonatal jaundice?
To inhibit heme oxygenase
What is the purpose of using phenobarbitone in the treatment of neonatal jaundice?
To stimulate cytochrome p450 enzymes
What is NOT a treatment modality for neonatal jaundice?
Sunlight exposure
What is the peak period for physiologic unconjugated hyperbilirubinemia in term newborns?
Day 4-6
What are the primary causes of conjugated hyperbilirubinemia?
Hepatic and non-hepatic causes
What is the most common treatment for neonatal jaundice?
Phototherapy
What is the primary method for diagnosing neonatal jaundice?
Measuring serum bilirubin levels
What can kernicterus lead to?
Cerebral palsy, deafness, impaired upward gaze, dental dysplasia
What is the primary cause of unconjugated hyperbilirubinemia in newborns?
Physiologic nd Pathological factors
What is the primary cause of conjugated hyperbilirubinemia in non-hepatic cases?
Galactosemia,Biliaryatresia, anti-trysin def. cystic fibrosis, cyst
What is the primary cause of hemolytic intrinsic jaundice?
All of the above
What is the primary method for treating severe neonatal jaundice?
Exchange blood transfusion
What are the primary causes of non-haemolytic jaundice?
B P S H C
What is the main excretory pathway for bilirubin?
Bile into the intestine
Match the following with their potential effects on bilirubin levels:
Hypoalbuminemia = May result in increased bilirubin levels Free bilirubin entering neurons = May result in increased bilirubin levels Increased serum bilirubin levels = May result in clinical jaundice Toxic hyperbilirubinemia = May result in kernicterus
Match the following with their potential effects on bilirubin levels in newborns:
Increased serum bilirubin levels = May result in clinical jaundice Toxic hyperbilirubinemia = May result in kernicterus Bilirubin index of 20mg/dL = Below which bilirubin must be kept to avoid increased risk of kernicterus serum bilirubin levels of 5mg/dL = Levels at which clinical jaundice is evident
Match the following with their potential effects on bilirubin levels and risk of kernicterus:
Bilirubin index of 20mg/dL = Associated with increased risk of kernicterus Exact levels above which bilirubin would cause brain damage = 20mg/dL and more Certain factors like hypoxia, acidosis, prematurity, infection, hypoalbuminemia and ICH = Reduce the integrity of the BBB Blood-brain barrier = Plays an important role in protecting the brain
Match the treatment modality with its indication:
Single volume Exchange Blood Transfusion (EBT) = Severe anaemia and severe sepsis Double volume Exchange Blood Transfusion (EBT) = Severe hyperbilirubinemia Pharmacotherapy = Stimulation of cytochrome p450 enzymes in the liver Use of protoporphyins = Inhibition of heme oxygenase
Match the treatment procedure with the associated action:
Calcium gluconate administration during EBT = Given after every 100mls of blood exchanged Use of 10% dextrose during EBT = Given with a top-up blood volume at the end of the exchange Sunlight exposure = NOT a treatment for any form of NNJ Use of phenobarbitone = Stimulation of cytochrome p450 enzymes in the liver
Match the following serum bilirubin levels with their respective body locations in neonatal jaundice:
5mg/dl = Face 10mg/dl = Trunk 15mg/dl = Abdomen and mid-thigh 20mg/dl = Feet
Match the following causes of jaundice with their descriptions:
Overproduction or decreased conjugation and clearance of bilirubin = Causes of jaundice Hepatic or non-hepatic causes = Conjugated hyperbilirubinemia Pathologic or physiologic = Unconjugated hyperbilirubinemia Membrane defects and enzyme abnormalities = Haemolytic intrinsic causes
Match the following hepatic causes of conjugated hyperbilirubinemia with their respective conditions:
Sepsis, TORCH infection, and hepatitis A&B infections = Hepatic causes Galactosemia, α 1-antitrypsin deficiency, and biliary atresia = Non-hepatic causes Breastfeeding jaundice, polycythemia,sepsis, hypothyroid, ceph = Non-haemolytic causes Alloimmune causes like ABO incompatibility = Extrinsic causes
Match the following treatment options for neonatal jaundice with their descriptions:
Prophylaxis in at-risk newborns and mild to moderate unconjugated hyperbilirubinemia = Phototherapy Involves the removal and exchange of blood volume with freshly donated whole blood = Exchange blood transfusion (EBT) Most common treatment for neonatal jaundice = Phototherapy May be required in severe cases = Exchange blood transfusion (EBT)
Match the following intrinsic causes of jaundice with their respective categories:
Membrane defects and enzyme abnormalities = Haemolytic intrinsic causes Sepsis, TORCH infection, and hepatitis A&B infections = Non-haemolytic causes Breastfeeding jaundice, breast milk jaundice, polycythemia = Non-haemolytic causes Galactosemia, α 1-antitrypsin deficiency, and biliary atresia = Non-haemolytic causes
Match the following indications for exchange blood transfusion (EBT) with their descriptions:
Mild to moderate unconjugated hyperbilirubinemia = Not an indication for EBT Severe cases of neonatal jaundice = Indication for EBT Prophylaxis in at-risk newborns = Not an indication for EBT Moderate to severe unconjugated hyperbilirubinemia = Indication for EBT
Study Notes
Neonatal Jaundice: Causes, Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment
- Neonatal jaundice levels vary across the body: face ≈ 5mg/dl, trunk ≈ 10mg/dl, abdomen and mid-thigh ≈ 15mg/dl, and feet ≈ 20mg/dl.
- Pathophysiology involves breakdown of heme by heme oxygenase, leading to the formation of biliverdin, which is then metabolized to bilirubin and excreted through bile into the intestine.
- Causes of jaundice may be due to overproduction or decreased conjugation and clearance of bilirubin.
- Conjugated hyperbilirubinemia may result from hepatic or non-hepatic causes, while unconjugated hyperbilirubinemia can be pathologic or physiologic.
- Hepatic causes of conjugated hyperbilirubinemia include sepsis, TORCH infection, and hepatitis A&B infections, while non-hepatic causes include galactosemia, α 1-antitrypsin deficiency, and biliary atresia, among others.
- Physiologic unconjugated hyperbilirubinemia peaks at days 4-6 in term newborns and later in preterms, rarely rising to 15mg/dl.
- Haemolytic intrinsic causes include membrane defects and enzyme abnormalities, while extrinsic causes include alloimmune causes like ABO incompatibility.
- Non-haemolytic causes of jaundice include breastfeeding jaundice, breast milk jaundice, polycythemia, sepsis, and hypothyroidism, among others.
- Kernicterus, caused by high levels of bilirubin, can lead to lethargy, hypotonia, hypertonia, and long-term sequelae like cerebral palsy and sensorineural deafness.
- Diagnosis involves clinical assessment and measuring serum bilirubin levels, with a transcutaneous bilirubinometer being a common tool.
- Phototherapy using specific light wavelengths is the most common treatment for neonatal jaundice, indicated for prophylaxis in at-risk newborns and mild to moderate unconjugated hyperbilirubinemia.
- Exchange blood transfusion (EBT) may be required in severe cases, involving the removal and exchange of blood volume with freshly donated whole blood compatible with the child and mother.
Neonatal Jaundice: Causes, Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment
- Neonatal jaundice levels vary across the body: face ≈ 5mg/dl, trunk ≈ 10mg/dl, abdomen and mid-thigh ≈ 15mg/dl, and feet ≈ 20mg/dl.
- Pathophysiology involves breakdown of heme by heme oxygenase, leading to the formation of biliverdin, which is then metabolized to bilirubin and excreted through bile into the intestine.
- Causes of jaundice may be due to overproduction or decreased conjugation and clearance of bilirubin.
- Conjugated hyperbilirubinemia may result from hepatic or non-hepatic causes, while unconjugated hyperbilirubinemia can be pathologic or physiologic.
- Hepatic causes of conjugated hyperbilirubinemia include sepsis, TORCH infection, and hepatitis A&B infections, while non-hepatic causes include galactosemia, α 1-antitrypsin deficiency, and biliary atresia, among others.
- Physiologic unconjugated hyperbilirubinemia peaks at days 4-6 in term newborns and later in preterms, rarely rising to 15mg/dl.
- Haemolytic intrinsic causes include membrane defects and enzyme abnormalities, while extrinsic causes include alloimmune causes like ABO incompatibility.
- Non-haemolytic causes of jaundice include breastfeeding jaundice, breast milk jaundice, polycythemia, sepsis, and hypothyroidism, among others.
- Kernicterus, caused by high levels of bilirubin, can lead to lethargy, hypotonia, hypertonia, and long-term sequelae like cerebral palsy and sensorineural deafness.
- Diagnosis involves clinical assessment and measuring serum bilirubin levels, with a transcutaneous bilirubinometer being a common tool.
- Phototherapy using specific light wavelengths is the most common treatment for neonatal jaundice, indicated for prophylaxis in at-risk newborns and mild to moderate unconjugated hyperbilirubinemia.
- Exchange blood transfusion (EBT) may be required in severe cases, involving the removal and exchange of blood volume with freshly donated whole blood compatible with the child and mother.
Test your knowledge of neonatal jaundice with this quiz covering causes, pathophysiology, clinical manifestations, diagnosis, and treatment. Learn about the varying jaundice levels in different body parts, the different types of hyperbilirubinemia, causes including haemolytic and non-haemolytic factors, and potential complications like kernicterus. Understand the diagnostic process, including serum bilirubin levels and transcutaneous bilirubinometer use, as well as
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