Tasty Morsels of EM 103 – #FRCEM Neonatal jaundice

2 Aug

I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.

You can find more things on the FRCEM on this site here

From OHEM 4th p 660 and NICE 2016

What is Physiologic Jaundice?

  • inability of the neonatal liver to deal with the normal rate of bilirubin production from red cell turn over
  • of note breast milk jaundice is related to substance that inhibit gluconyl transferase

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High risk babies

  • <38 weeks
  • sibling who needed photorx
  • intention for exclusive breast feeding
  • jaundice in <24 hrs

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Jaundice in first 24 hrs

  • this is rare and a red flag
  • measure serum within 2 hrs of suspecting it (good luck there…)
  • measure it every 6 hrs

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Jaundice in >24 hrss

  • 6 hours to measure it following suspicion
  • can use a non invasive device

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Factors increasing risk of kernicterus

  • >340 in babies >37 weeks
  • rapid rise
  • clinical features of encephalopathy

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Spoiler

what do you do when it’s not getting better?

  • gestational age >37 and jaundice more than 14 days:
    • look for chalky stools
    • check conjgated bili (have they got bilairy atresia)
    • FBC
    • blood group and coombs (is this a haemolytic problem)
    • ensure heel prick was alright (congenital hypothyroid)

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