Page 1 of 1: OSCE-Buster: Neonatal Joundice - Counsel parents

sajida · Credits: 105747 My Scrapbook My Reading List 6 Books

Counsel the parents of an 18hr old baby who is noticed to be jaundiced. Discuss the causes and treatment options.

Early neonatal jaundice

Physiological jaundice of the newborn (unconjugated hyperbilirubinemia), which is due to immaturity of the liver, is usually first noticed on day 2 or 3 of life and reaches a peak on day 4-6 of life and then starts resolving. If the bilirubin levels are high will need treatment.

Early neonatal jaundice – jaundice within 24 hrs of age

Causes: Haemolysis – Rh or ABO
Sepsis
Hepatitis – congenital infections (TORCH – Toxoplasmosis, Rubella,
CMV, Hepatitis)

What is jaundice?

Jaundice is the yellow discolouration of the skin and mucous membranes caused by high levels of a pigment called bilirubin in the blood.

What causes neonatal jaundice?

Most normal newborns develop jaundice on the 2nd or 3rd day of life due to the immaturity of the liver and this reaches a peak by 5-6 days of age and then gradually resolves. This usually does not need treatment but if the pigment levels are very high it might need to be treated.

Sometimes jaundice can appear early on in life within the first 24 hours and this is often due to mismatch between the baby’s blood group and the mother’s blood group. Sometimes the presence of infection can cause a similar picture and rarely metabolic disorders can produce early jaundice.

Is jaundice dangerous to the baby?

If the jaundice pigment is within safe levels it usually causes no problems however, especially with blood group mismatch there is a tendency for the jaundice levels to reach very high levels and this can potentially cause brain damage and fits and needs treatment.

How can it be treated?

There are two parts to treating this condition –

a. Bringing the amount of pigment in the blood down to safe levels: This is done by using a powerful lamp, which produces a special light wave that converts the harmful pigment into a harmless form that is excreted by the kidneys. Sometimes with high levels of jaundice more than one lamp might need to be used. Rarely even this is not adequate and we then need to take out some of the baby’s blood containing the pigment and replace it with saline or donor blood.
b. Treating the underlying cause e.g. antibiotics for infection.

How does blood mismatch occur?

If the mother’s blood is of a different group to the baby’s blood, it can result in the formation of what are called antibodies in the mother. These antibodies are passed on to the baby in the womb and after birth these can attack the baby’s blood cells releasing jaundice pigment into the blood. The antibodies tend to disappear over several days and the only treatment is treatment of the jaundice.

Can this happen again if I get pregnant?

This depends on the type of blood mismatch you have and the blood group of your next baby. If the mismatch is what is called an Rh mismatch, that is you are Rh antigen negative and the baby is positive you produce antibodies to the antigen and this destroys the baby’s blood calls giving rise to jaundice. If the next baby is also positive you might have a similar problem, in fact it might be slightly worse but you will be closely monitored during your pregnancy.

sepplabber · Credits: 9540 My Scrapbook

thanks

Roche · Credits: 1185 My Scrapbook

Thanks

Here r a few suggestions.

Greet the mother,introduce yourself.

"As I understnd,u r clearly worried abt ur baby being jaundiced.Is that right?"

Let me explain to u..it is very much normal for newborns to look yellow or in other words jaundiced in the first few days of life.

It is a normal hing to happen and is going to resolve in a few days time.
Jaundice occurs in newborns bcoz of a substance called bilirubin.Newborns r unable to clear ths substance from their body easliy bcoz their systems r immature and r still developing.Howevr ths resolves in a few days time.

THers no need to do any blood tests n he doesnt need to stay in the hospital.
Only make sure he is being fed well.
Our health worker is going to keep an eye and would let us know if jaundice doesnt resolve.
Is that alright?

Il give u some info leaflets about newborn jaundice.i know ul have lots of questions,but i can always come back n answer them for u.is that ok?

Thank you..

HRWD · Credits: 692 My Scrapbook

terrific post,thanks

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