2.3 Developmental Assessment - common neonatal skin conditions and HEENT conditions - Jaundice Flashcards
What is jaundice
aka neonatal hyperbilirubinemia
accumulation of bilirubin in the skin
Approximately 60% of term newborns are jaundiced in the first week of life
What clinical observation indicates jaundice
orange/yellow or green hue to skin
typically apparent when serum bilirubin lev-
els exceed 5 to 7 mg/dL
When does jaundice occur and resolve
occurs around 3rd day of life; resolves around have 10-12
asian babies develop it a bit later and resolves a bit later
How can jaundice be impacted by breast feeding
can get early and late onset jaundice - typically as result of infrequent and insufficient intake leading to decreased intestinal motility
What are the 5 common reasons for jaundice
- increased hemolysis (isoimmunization-mothers immune system attacks babys RBCs causing lysis)
- Polycythemia (increased RBC mass)
- Delayed cord clamping (baby gets increased blood from placenta)
- Liver immaturity or defects
- Abnormal excretion or absorption like delayed stooling
The following are risk factors for the devel-
opment of pathologic hyperbilirubinemia:
- Hemolytic disease, anemia
- Inborn errors of metabolism
- Prematurity (gestational age 35 to 36 weeks)
- Significant bruising or cephalohematoma
- Exclusive breastfeeding with significant weight loss or difficulty
in feeding - Jaundice that develops in the first 24 hours of life
- The total bilirubin increases more than 5 mg/dL/24 hours, is
more than 12.5 mg/dL before 48 hours old, or the direct bili-
rubin exceeds 2 mg/dL
- Ethnic or geographic origin associated with hemolytic anemia
(African or Mediterranean descent) - Hepatobiliary disease
- Previous sibling required phototherapy
FYI signs of jaundice
- Petechiae, bruising, hepatosplenomegaly, or signs of infection
- Lethargy, hypotonia, poor feeding, and loss of the Moro reflex
are common initial signs of bilirubin toxicity to the brain (ker-
nicterus). These symptoms are subtle and indistinguishable
from those of sepsis, asphyxia, hypoglycemia, intracranial hem-
orrhage, and other acute illnesses in the neonate.
- Later signs of kernicterus include diminished tendon reflexes,
respiratory distress, failure to suck, opisthotonos, bulging fon-
tanelle, twitching of face or limbs, seizures, and a shrill, high-
pitched cry.
What are common treatments of jaundice
- Phototherapy
- regular breastfeeding 8-12x per day
What is the best preventor of SIDS
sudden infant death syndrome
placing newborn supine instead of face down to sleep
most SIDS liked to suffocation
FYI Three main pathophysiologic mechanisms are considered to
contribute to SIDS: decreased arousal, asphyxia and rebreathing,
and thermal stress. Experts consider as possible causes respiratory
obstruction, restrictive clothing, and hyperthermia. Factors associ-
ated with SIDS include precious BRUE, poverty, lack of prenatal
care, low birth weight, SGA, preterm birth, young maternal age,
high parity, maternal smoking and drug use, and co-sleeping.
FYI
* Breastfeeding is recommended.
* Infants should be immunized (reduces risk by 50%).
* Place infants on their backs to sleep until at least 6 months old. The
National Institutes of Health has a “Safe to Sleep” program with parent
information, stickers, and video.
* Use a firm mattress. Do not use bumper pads, soft bedding, comforters,
or have stuffed animals in bed. Infants should not sleep on a sofa or
chair, on a waterbed, or in bed with an adult.
* Avoid overheating or too much sleepwear; room temperature should be
68°F–72°F (20°C–22.2°C).
* Avoid alcohol and drugs (including tobacco) while pregnant and
breastfeeding, and while in bed.
* Do not allow cigarette smoking within the house or car.
* Avoid bed sharing and co-sleeping.
* Separate but proximate caregiver sleeping environments are
recommended for the first 6 months to a year of life.
* Consider pacifier use at naptime and bedtime once breastfeeding
established.
