6do w/ jaundice Flashcards
what are the signs of bilirubin encephalopathy in the first few weeks of life
poor suck, high pitched cry, hypotonia, lethargy, seizures
later: extensor hypotonia, opisthotonus
Serum bili do not predict bili toxicity. When the bili is more than 20-25 what are the risk factors for toxicity?
Hemolysis (isoimmune hemolytic disease, G6PD) Asphyxia Significant lethargy Temperature instability Sepsis Acidosis Albumin <3.0 g/dL
What was a common cause of kernicterus before certain screening tests were available during pregnancy?
Rh incompatibility causing erythroblastosis fetalis
Risk factors for development of severe hyperbilirubinemia in infants of 35+ weeks gestation
Breastfeeding
ABO mismatch/Rh-d
Mediterranean ethnicity
Physiologic Jaundice defined as Tbili of ____and peaks on what day
< or equal to 15mg/dL
peaks at day 3-4
What does meconium and breast milk contain that can exaggerate newborn jaundice?
beta-glucoronidase. It increased the deconjugation and enterohepatic recirculation of bilirubin
Breast feeding jaundice happens when
first week of life when milk supply is a little low–>low GI motility–>increased retention of meconium and beta-glucoronidase
Breast milk Jaundice happens when and why?
Breastmilk jaundice begins in the first 4-7 days, can peak around 10-14 days.
can persist for up to 12 weeks
Coombs positive/Antibody positive hemolysis can be from
Rh incompatibility, ABO incompitability (weakly positive), minor blood antigen incompatibility
Non hemolytic causes of RBC breakdown include
Bruising from birth trauma
Large cephalohematoma/hemorrhage
Polycythemia
Swallowed blood during delivery
Rare causes of severe unconjugated hyperbilirbuninema
Crigler-Najjar
Gilbert Syndrome
Galactosemia and hypothyroidism
What are common voiding patterns in newborns: Day3, Day6
Day 3: 3-4 voids, no longer passing meconium
Day 6: 6-8 voids, 3-4 stools/day but infants may pass stool with every feeding
What are the major risk factors for severe hyperbilirubinemia
pre-discharge bili in the high risk zone jaundice w/in 24 hours Blood group incompatibility Gestational age 35-36year previous sibling requiring phototherapy cephalohematoma or bruising exclusive breastfeeding East asian
what is the difference between cephalohematoma and caput succedaneum?
cephalohematoma DOES NOT cross the suture lines
caput succedaneum: crosses suture lines because it is swelling that overlies the periosteum
liver edge palpable ___cm below inferior costal margin is normal finding in a newborn
1cm
