Neonatal Jaundice Late2013

Front 1

Why are neonates more susceptible to Kernicterus?
Is Kernicterus associated with conjugated or unconjugated bilirubin?

Back 1

They have a more permeable blood brain barrier.
Kernicterus is associated with UNCONJUGATED bilirubin.

Front 2

What are red flags for pathological jaundice?

Back 2

1. Jaundice at <24hrs of age
2. Serum unconjugated bilirubin rises rapidly
3. Persistent jaundice lasting beyond 1-2 weeks
4. Conjugated hyperbilirubinemia >10% of total

Front 3

What are the key initial investigations for a child with jaundice?

Back 3

1. Baby’s and mom’s blood group
2. DAT (Coombs)
3. CBC and differential, smear and reticulocyte count
4. Conjugated and unconjugated serum bilirubin
5. G6PD (especially if male and racial background at risk e.g., SE Asia)
6. Blood culture, urine culture if concerns of sepsis
7. ultrasound if conjugated

Front 4

What are risk factors for severe hyperbilirubinemia?

Back 4

1. Pre-discharge total serum bilirubin (TSB) or total / unconjugated bilirubin level in the high-risk zone
2. Jaundice observed in the first 24 hours of life
3. Blood group incompatibility with positive direct antiglobulin test (DAT)
4. Gestational age < 37 week
5. Previous sibling received phototherapy
6. Cephalohematoma or significant bruising
7. Exclusive breastfeeding, particularly if nursing is not going well and weight loss is excessive
8. East Asian race

Front 5

What are the clinical features of kernicterus?

Back 5

mental retardation, dental abnormalities, choreo-athetoid movements, sensorineural hearing loss, upward gaze palsy, hypotonic initially, hypertonic with time, cerebral palsy

Front 6

What are risk factors for kernicterus?

Back 6

prematurity, asphyxia, and sepsis

Front 7

At what concentration of unconjugated bilirubin does kernicterus usually occur?

Back 7

> 425 μmol/L

Front 8

Where in the brain does bilirubin accumulate in kernicterus?

Back 8

basal ganglia, pons, and cerebellum