5.1 - Jaundice Flashcards
EXAM
Four processes occur in the metabolism of bilirubin
- Production
- Transport
- Conjugation
- Excretion
EXAM
Bilirubin Metabolism
- fetal red blood cells to make way of the neonate RBC
- Bilirubin detaches from the RBC (haem)
- Attaches to Albumin
- Process through them liver and eliminated by the way of faeces
- Bilirubin requires glucose and 02 to make it water soluble bilirubin
- Bilirubin detaches from the redblood cells
- attaches to albumin to arrive at the liver
- within the liver the bilirubin requires glucose & 02
- excreted in the urine (urobilirgan) & faeces (Stercobilinogen)
EXAM
Bilirubin Production
- ageing red blood cells
- Red cells are distroyed
- the haem is conververted into unconjugated bilirubin
*
EXAM
Management of Jaudice in the neonatal
- Conservative
- regular bilirubin levels
- vital signs assessment
- observation of feeding patters
- phototherapy
- Extreme situations
- Exchange transfusion
EXAM
Hyperbilirubineania
- ^ Production
- Decrease clearance
- ^enterohepatic circulation
- Yellow discolouration of the skin, sclera and mucous membranes due to the disposition of bilirubun
- 60% of newborns
- 80% premature infnacts
- Risk factors
- severe jaundice occurring within the first 24 hours & blood group incompatiblity
- Late onset after 2 weeks
EXAM
Discuss the care and management of the infant with jaundice including midwifery responsibilities in care for the neonate reviving Phototherapy
- Temperture control
- Eye shields/patches
- Observation for any eye discharge
- skin assessment
- skin dryness
- PAC
- rashes
- Hydration status & feeding behaviours
- responsiveness to activity
- ongiong SBR to monitor levels
- nesting & comfort
EXAM
Risk Factors for hyper bilirubinaemia
Maternal
- GDM
- Incompatibly blood
- maternal sepsis
- Congenital condition
- G6PD hereditary spherocytosis
- breast milk jaundice
Infant
- delayed cord clamping
- DAT
- Trauma
- preterm
- incompatibly blood
- immaturity
- poor Feeding
- FGR
- sepsis
- TTT -to twin to twin
- Cold stress
- delayed passage of meconium
- biliary atresia
EXAM
Neonatal differences reason for jaundice
Physiologic jaundice
- ^HGB release
- ^RBC turnover
- HCT 50-60%
- 2-3x more bilirubin
- decrease bilirubin clearance
- immature enzyme (1% activity)
- ^Enterohepatic circulation
EXAM
Jaundice Pathological
- J - Jaundice within the first 24 hours
- A - a sibling who required phototherapy in the neonatal period
- U - unrecognised haemolysis
- N - non-optimal sucking/feeding
- D - g6pd deficiency (rare)
- I - infection
- C - cephalohematoma or bruising
- E - ethnicity - Asia heritage
An increased destruction of red blood cell is called
*
Unconjagted bilirubin in the blood is bound to
- serum albumin
- transported to the liver
- Not water soluble
- unconjugated bilirubin is fat soluble
*
Factors that decrease the albumin binding ability
- Infection
- Acidosis
- Prematiurty
- Hypoclycaemia
Conjucated bilirubin when combined with glucose
- becomes water soluble
- excreted by the kidneys
- entered into the bile
- and out through the small intestine
- bacteria in the small intestines enable the bilirubin to reduce to “Stercobilinogen”
- note: Uncongjucation bilirubin absorbs into the bowl and entering the liver metabolism: enterohepatic circulation
Phototherapy
- common therapy for the treatment of jaundice
- converts bilirubin to photochemical products that become water soluble
- then can be extrected by urine & bile without the need for conjucation
Ongoing high bilirubin levles can cause
- Increasing jaundice
- Kernicterus
- when bilirubin deposits cause potential damage to areas of the brain
- Poor hyudration status
- adds to increasing bilirubin levels
*
- adds to increasing bilirubin levels
Things to help with lower jaundice instances
- early breastfeeding
- ```
Production (RBC Turnover)
- Isoimmune hemolytic anemia
- RH/ABO incompatible\
- Cephalohematoma
- RBC reservior
- Polycythermia
- eg IDM
- RBC defects
- spheroctosis
- G6PD
- 1st week of life
Impaired bilribun clearance
- enzyme impairment
- Decrease production (gilbert’s)
- Decrease Function (crigler-najjar)
- Galactosemia
- Congenital hypothyroid
after 1st week of life
Phototherapy
- Spectrum of the light
- Photiosmerization & oxidization
- blue light 460 - 490 wave
- sufficiently high irradiance
- intensive phototherapy . uw/cm2/nm
- between pt and light a mininum of 30cm
- effective surface area
- exposure as much of surface area
- protect again retinal damage place eye shield
*
How does phototherapy work
Pathological jaundice
too early -
- Blood (abo) incompatibility
- spesis
*
top long
- 2gpd
- breast milk jaundice
- Liver
- bilriumtresis
*
mentimeter
d
The later preterm infant is
as risk of hyperbilirubinaemia
Case study
Pathological jaundice
“Too early”
- Less than 24 hours old
- Bruising and birth trauma
- ABO incompatibility
- Sepsis
“Too long”
- G6PD
- Breastmilk jaundice
- low milk supply/
- not feeding properly
- increase destruction of RBC
- Prematurity
- bilariesia
“Too much”
- ABO incompatibility
- prematurity
- NEC
- FGR
- Immature liver
- Lack of glucose
Case study
Plan of care for baby Julia
Potential problems/complications
- Pathological jaundice
- Kernicterus
- poor feeding
- lethargy
- reduced hydration
- separation
- breastfeeding interrupted and impacted
Goals of care/planning including neurodevelopment outcomes
- family centred
- intervene
- cluster care
- regular frequent BF
- Monitoring
- SBR
- eye health
- pressure area care
- hydration - FBC
- nesting
- development care
Interventions including rationale-neonatal and maternal family
- increase fluid intake - FBC
- Lights - biliblanket - physiological dingle, double triple lights
- promote breastfeeding increasing supply, cikibuses gut, assist excreting bilirubin
- monitoring
Evaluation of care
SBR under 50
consider cause
insure output increasing
yellow skin colour improving
