A Clinical Atlas of Chinese Infants

Section 7. Jaundice (Photos 136-144)

SECTION7 1 JAUNDICE (photos 136-144) 137 138 136-138 Neonatal jaundice. This is a prevalent problem among Chinese newborn in Hong Kong within the first few weeks of life (Yeung & Field, 1969; Li et aI., 1978). In most cases, the cause is 'non-specific', but some develop severe jaundice (136) that can cause brain damage. The baby in ( l37) shows opisthothonus and rigid posture as evidence of bilirubin encephalopathy. Long term sequelae includes athetoid cerebral palsy (138) and high frequency nerve deafness in later life. Factors which aggravate unconjugated bilirubinaemia include haemolysis, infection, and absorption of blood pigments. Male babies with erythrocyte glucose-6-phosphate dehydrogenase deficiency should be closely monitored for haemolysis. .. 139 . 40 139. 140 Phototherapy.The pictureshows a jaundiced neonate receiving phototherapy with the light coming from around, as well as above and below the incubator (139). Light at a wavelength between 300 and 600 run, with an intensity of 2ClO-400 ft candles of light has been proven to beeffective treatment. During phototherapy the baby's eyes should be shielded. In some newborns, a peculiar bronze colour develops after light exposure (140). 141 142 141 Exchange transfusion. In this picture the baby is undergoing exchange transfusion because the unconjugated bilirubin level greatly exceeds 20 mg% (or 340 umol/ L) which may result in brain damage. Exchange transfusion with 200 m L of fresh donor blood per kilogram baby's weight is still the fastest way to curb the further rise in bilinlbin level, and is a safe procedure in experienced hands. 142 Biliaryatresia. 11Us2month -old baby with biliary atresia develops a yellowish green colour distinct from the neonatal jaundice commonly seen, and her liver and spleen are enlarged. It is not always easy to distinguish biliary atresia from neonatal hepatitis. Nevertheless it is important to make the distinction because early surgery, including the Kasai operation, can minimize the chance of developing liver cirrhosis. Some centres now offer liver transplantation as a new treatment modality to babies with cirrhosis. 144 .143. 1.44 Choledochal cyst. This female infant has recurrent jaundice since birth due to undiagnosed choledochal cyst (143). In barium meal film, a large cyst can be seen (1.44). Nowadays, ultrasound and operalivecholangiogram are useful ways to confirm the diagnosis. Treatment is surgical. The cause for the dilatation of part, or all of the extrahepatic ducts in this condition is unknown. There is a female predominance. Untreated patients may develop biliary cirrhosis. ...