32 HOW TO TREAT : NEONATAL JAUNDICE
32 HOW TO TREAT : NEONATAL JAUNDICE
8 DECEMBER 2023 ausdoc . com . au
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Rabelo N , et al . Arquivos de Neuro-Psiquiatria 2017 / CC BY 4.0 / bit . ly / 3ZrQCY5
Figure 7 . Cephalohaematoma . A . Illustration of skull deformation during birth with vertex presentation . Compression of the frontal and occipital bones ( solid arrows ), the parietal bones are pressed out ( dashed arrow ). B . Axial picture of a newborn with cephalohaematoma in the left parietal area of the head . C . Plain X-ray showing parietal lineal fracture ( white arrows ).
gender , breastfed , family history and weight loss . Investigations include SBR and conjugated fraction , blood group , DAT and electrolytes . Investigations to consider include TCB , G6PD assay , FBC , blood gas and BSL .
James ’ SBR is 365 µ mol / L , which requires phototherapy , and his conjugated bilirubin is 9 µ mol / L . Note that unconjugated bilirubin is time and gestation dependent ( see standard charts ) and the conjugated should be less than 10 %. The SBR is plotted on the local phototherapy treatment threshold guideline . The GP contacts the local on-call hospital paediatrician to arrange admission for phototherapy and follow-up of investigations . If one is in a rural or remote location , consider calling the state retrieval service to co-ordinate and facilitate care . Liaison with community early childhood services is advised .
Case study two
Layla , a term female baby presents for GP review at 18 days of age with persistent jaundice . She was born in good condition , with a birthweight of 2.9kg , at 39 weeks ’ gestation following uncomplicated pregnancy and spontaneous labour . She is a second child , and there is no family history of jaundice . Mum is blood group A positive . Layla has been exclusively breastfed since birth and produces plentiful wet and dirty nappies .
On examination , Layla is noted to be an active baby with normal behaviour , tone and movements . She is jaundiced throughout her face and sclera . Her heart rate is 118bpm , respiratory rate is 34 breaths per minute , temperature 36.6 ° C , oxygen saturation ( on the lower limb ) 98 % and she weighs 3.4kg . Cardiac , respiratory and abdominal examinations are normal . On checking her nappy , stool is visualised and noted to be pigmented and not pale . There is no sign or history of dark urine .
Breastfeeding is an identified risk factor for jaundice .
The investigations ordered are SBR and the conjugated / direct fraction , blood group , DAT , electrolytes , and thyroid function tests . Tests to consider include TCB , urine culture , metabolic screen , G6PD assay , FBC , blood gas and BSL .
SBR is 184μmol / L , conjugated is 8μmol / L . Note that unconjugated bilirubin is time and gestation dependent
Figure 8 . Phototherapy .
Uncontrolled document when printedUpdated / Formatted : ( 25 / 01 / 2019 ) Approved by Clinical Director Neonates 25 / 01 / 2019 Page 11 of 14
Figure 9 . Phototherapy chart .
Source : The Royal Women ’ s Hospital — Jaundice ( hyperbilirubinaemia ) in newborn babies ≥ 35 weeks gestation guideline . bit . ly / 41RlEu6
Image used with permission : The Royal Women ’ s Hospital , Melbourne , Victoria .