PAEDIATRICS

ResponseMaternal

• Blood group (ABO incompatibility)
• Previously jaundiced child
• Poorly controlled diabetes
• FHx inherited haemolytic disorders (G6PD, hereditary spherocytosis)
• Prev siblings needing phototherapy

Neonatal

• Poor/inadequate feeding
• Prematurity
• Birth trauma - instrumental delivery
• Sepsis/infection
• All the diseases you’re about to be asked about

ResponseKernicterus - Chronic bilirubin encephalopathy
Complications
Acute - Seizures, coma
Chronic - Cerebral palsy, developmental delay, Death

ResponsePhysiologic jaundice due to immature hepatocytes
Breast milk jaundice - well child, onset D3-4, lasts a few weeks, settles by week 3
Haematoma breakdown

ResponseSepsis (onset any time) - fever/tachycardia - think TORCH infection
Haemolysis - rhesus or ABO incompatibiilty (<24h old), anaemia, Raised LDH
Liver - hepatitis, congenital biliary atresia - conjugated hyperbilrubinaemia, pale/dark stools
Metabolic - alpha 1 antitrypsin deficiency
Bowel obstruction
Hypothyroid

RCH - <24h = always bad - think sepsis or haemolysis. 24h-14d think other causes.

ResponseTime of onset <24hr ALWAYS pathological
Accompanying symptoms - fever/unsettled - infection/sepsis as cause
Feeding/weight gain - Inadequate nutrition/hydration as contributor
Stool/urine colour - Dark urine/pale stools - conjugated vs unconjugated
FHx haemolytic conditions - G6PD, spherocytosis etc. - potential cause
Birth history - prematurity, traumatic birth, cephalohaematoma, blood group- risk factors for jaundice
Neonatal screening - ? congenital disorder eg: hypothyroidism

ResponseVitals - well/sick, ? sepsis
Growth parameters - Failure to thrive suggests poor nutrition/chronic disease
Dysmorphic featrures - Genetic disorder eg Alagille syndrome
Abdominal mass - Choledocal cyst
Hepatosplenomegaly - Metabolic/storage disorder, viral hepatitis

ResponseHigh levels pose higher risk. Interpretation dependent on prematurity - term can handle higher levels
Conjugated vs unconjugated. Conjugated worse as suggests obstructive cause

ResponseSerum bilirubin (Conjugated Bili >25% (RCH says 10%) or total bili>200 is bad)
FBC, film and reticulocytes
Coombs test (Direct antigen test) - ?ABO incompatibility
Sepsis - FBC, CRP, Blood/urine culture, LP
Haemolysis - FBC + Film, G+H, Haptoglobin, LDH, Coombs test, G6PD
Liver - LFT (Function/obstruction), U/S
TFT
Ammonia, pyruvate, lactate
US Abdomen if conjugated bili high ? biliary atresia and duct dilation

ResponseReassuring physical, normal obs, well looking child (albeit a bit yellow)
Period of observation and feeding
Bili <200, Conjugated bili <25
No concerning cause found
Adequate follow up organised