08: 6-day-old female with jaundice

Question 1

What are the 2 main reasons that infants get jaundiced?

Answer 1

1. Underdeveloped liver can’t conjugate the bilirubin

2. Lack of GI flora to metabolize bile, so the bilirubin is re-unconjugated and sent back into the bloodstream

Question 2

What form of bilirubin can cross the BBB?

Answer 2

Unconjugated

Question 3

What 2 parts of the brain are affected by Kernicterus?

Answer 3

1. Basal ganglia

2. Cranial nerve nuclei

Question 4

What are the effects of kernicterus in the brain?

Answer 4

Tone/reflex abnormalities, choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss, cognitive impairment

Question 5

Aside from opioid withdrawal, what can cause a high-pitched cry in a newborn?

Answer 5

Acute bilirubin encephalopathy

Question 6

When does acute bilirubin encephalopathy occur?

Answer 6

Within the first few weeks of life

Question 7

What type of bilirubinemia does phototherapy cure?

Answer 7

Unconjugated

Question 8

What type of jaundice is

Answer 8

Physiologic jaundice

Question 9

Which type of jaundice happens the first week in life and is caused by a relatively low milk supply, leading to low enteric intake, decreased GI motility, and increased B-glucoronidase activity?

Answer 9

Breastfeeding (or lack of breast-mik) jaundice

Question 10

Which type of jaundice happens within the first 4-7 days of life but peaks around days 10-14, and has an unclear etiology?

Answer 10

Breast milk jaundice

Question 11

What test is positive in antibody-positive hemolysis, such as Rh, ABO, minor antigen incompatibility?

Answer 11

Direct COOMBS (DAT)

Question 12

What can bruising from birth trauma, large cephalohematoma, polycythemia, or swallowed blood during delivery all cause?

Answer 12

Jaundice due to non-hemolytic RBC breakdown

Question 13

What are 2 rarer causes of jaundice?

Answer 13

Crigler-Najjar and Gilbert Syndrome

Question 14

Can galactosemia and hypothyroidism cause jaundice?

Answer 14

Yes

Question 15

What might be the cause of jaundice in the newborn with hepatosplenomegaly, microcephaly and/or rash?

Answer 15

TORCH infection

Question 16

Which 3 infections does breastfeeding protect against?

Answer 16

1. Otitis media
2. Respiratory infections
3. Diarrhea

Question 17

Does breast milk contain growth factors?

Answer 17

Yes

Question 18

Is colostrum higher or lower in non-nutritive but beneficial substances?

Answer 18

Higher

Question 19

When can a child first drink unmodified cow milk?

Answer 19

Age 1

Question 20

Approximately 50% of calories in human milk come from ______?

Answer 20

Lipids

Question 21

Why is it important that an infant empty the breast before going to the next breast?

Answer 21

Because the highest lipid concentration is at the end of the session

Question 22

What’s the whey:casein ratio in breast milk?

Answer 22

70:30

Question 23

A healthy-appearing infant who develops jaundice, dark urine, and pale stools between 3-6 weeks may have ______ ______?

Answer 23

Biliary atresia

Question 24

Any infant who develops jaundice after 2 weeks of age must be evaluated with __________ bilirubin?

Answer 24

Fractionated (i.e., total and direct bilirubin levels)

Question 25

What surgical procedure can fix biliary atresia by anastomosing the intrahepatic bile ducts to a loop of intestine?

Answer 25

Kasai procedure

Question 26

How often should the infant urinate by day 3?

Answer 26

3 times

Question 27

How often should the infant urinate by day 6?

Answer 27

6 times

Question 28

What color should infant urine be?

Answer 28

Pale yellow

Question 29

What should the infant stool be like at day 3?

Answer 29

Meconium should be gone and stool appears yellow

Question 30

How many times should infants poop by day 6?

Answer 30

3-4, or after every feed

Question 31

Should infant stool smell bad?

Answer 31

No, it should have very little odor

Question 32

What's a subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery, and does NOT extend across suture lines?

Answer 32

Cephalohematoma

Question 33

What's an edematous swelling over the presenting portion of the scalp of an infant that has boggy swelling that DOES cross suture lines?

Answer 33

Caput succadaneum

Question 34

What's the average diameter of the anterior fontanelle?

Answer 34

2.5-5cm

Question 35

Is the posterior fontanelle palpable at birth or later in most full term newborns?

Answer 35

No

Question 36

Is a liver edge palpable 1cm below the inferior costal margin a normal finding in a newborn?

Answer 36

Yes

Question 37

What do infants with galactosemia present with (3)?

Answer 37

1. Hepatomegaly 2. Ascites 3. Edema

Question 38

Breastfed infants may lose up to ___% of their birthweight in the first 5 days?

Answer 38

10%

Question 39

What does Vitamin D rickets usually respond to?

Answer 39

Vitamin D

Question 40

At what age should babies receive fluoride supplements if their water lacks it?

Answer 40

6 months