SAQ 130 – Paediatrics – neonatal jaundice and ALTE
Model Answer
Question 9. neonatal jaundice and ALTE.
a. Causes by timing
| Time to onset of jaundice | Cause of neonatal jaundice |
|---|---|
| < 2 days | ABO incompatibility; Rh incompatibility; bacterial sepsis; TORCH infection; haemolysis such as G6PD deficiency. |
| 2-3 days | Physiological jaundice. |
| 3-7 days | Bacterial sepsis; toxoplasmosis; CMV. |
| > 1 week | Bacterial sepsis; hepatitis; congenital bile duct atresia; congenital haemolytic anaemia; drug-induced haemolytic anaemia; rubella; herpes; hypothyroidism; breast milk jaundice. |
b. Biochemical features
- Conjugated bilirubin.
- Serum bilirubin >13.
c. Management options
- Observe.
- Phototherapy.
- Exchange transfusion.
d. ALTE definition
- An episode frightening to the observer, characterised by some combination of apnoea, colour change, change in muscle tone, choking, or gagging.
e. Benign ALTE features
- Term child.
- Previously well.
- Symptoms temporally related to feeding.
f. Investigations for serious ALTE
- FBE and differential.
- Urea and electrolytes.
- Random blood glucose.
- Nasopharyngeal aspirate for viruses and pertussis.
- ECG, especially for QT interval.
- Consider lactate, ammonia, acylcarnitine profile, EEG, CT brain, Holter, toxicology screen, or metabolic screen in selected cases.
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