Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Infant with jaundice

Clinical Discipline(s)/Organ System(s)
General Surgery, Paediatrics
Progress Test Topic(s)
Child health
A 5 week old NZ European baby girl is referred to medical services as the postnatal midwife has noted she is jaundiced. The baby is breast feeding but not gaining weight well.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Fetal development of gastrointestinal tract
   - Anatomy and physiology of liver and biliary tract
   - Pathology of biliary atresia
   - Physiology and pathophysiology of neonatal jaundice and red cell degradation (physiological and pathological jaundice)
   - Normal growth and development of newborn
   - Cerebrospinal fluid, blood brain barrier and kernicterus
Clinical and Communication Skills 
   - List the common causes of jaundice in the newborn, infancy and older childhood
   - Take a neonatal and antenatal history
   - Differentiate biliary atresia (obstructive jaundice) from other causes of prolonged jaundice (red flags on history; pale stools, dark urine)
   - Physical examination of the newborn
   - Interpretation of basic laboratory tests to diagnose causes of neonatal jaundice and prolonged neonatal jaundice (classification of unconjugated and conjugated hyperbilirubinaemia with 'differential' bilirubin as a starting point before further investigation)
   - Recognise signs and symptoms suggestive of kernicterus (hypertonia, lethargy, high pitched cry, back arching)
   - Know how phototherapy works and when to use it
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Recognise when there is a critical need for referral and communication with other medical colleagues
Hauora Māori 
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations)compared with non-Māori in New Zealand (relevant to causes of jaundice)
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision making and management
   - Acknowledgement of the disproportionate impact of illness on whānau employment/income, and therefore availability and models of caregiving
Population Health 
   - Child and maternal health care providers in New Zealand
   - Paediatric surgical and transplant services in New Zealand
   - Epidemiology of jaundice in newborns
Conditions to be considered relating to this scenario
unconjugated hyperbilirubinaemia, breast milk jaundice, bacterial infection
Less common but 'important not to miss'
biliary atresia, cystic fibrosis, blood group incompatibility (unconjugated), hypothyroidism
metabolic disorders, congenital choledochal cyst, hepatitis (especially HepB), CMV, toxoplasmosis, rubella, syphilis, Epstein-Barr virus (EBV), parvovirus