8- jaundice Flashcards
bilirubin encephalopathy early and later signs
Initial signs -poor suck, high-pitched cry, hypotonia, lethargy, seizures
Later signs -extensor hypertonia, opisthotonus
kernicterus
high level of unconj. bili –> staining of the basal ganglia and cranial nerve nuclei by bilirubin.
choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss and cognitive impairment.
risk factors for bili toxicity
Hemolysis (e.g. isoimmune hemolytic disease, G6PD deficiency) Asphyxia Significant lethargy Temperature instability Sepsis Acidosis Albumin < 3.0 g/dL
physiologic jaundice
total bilirubin level ≤ 15 mg/dL (≤ 257 μmol/L) in full-term infants who are otherwise healthy and have no other demonstrable cause for elevated bilirubin.
self limiting
Numerous factors promote the increased enterohepatic circulation that results in physiologic jaundice:
Increased bilirubin production (from the breakdown of the short-lived fetal red cells) Relative deficiency of hepatocyte proteins and UDPGT Lack of intestinal flora to metabolize bile High levels of β-glucuronidase in meconium Minimal oral (enteral) intake in the first 2-4 days of life, resulting in slow excretion of meconium (especially common with breastfed infants).
Breastfeeding jaundice
1st week- low vol milk- dehydrated
–> retain meconium–> β-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing an elevation of serum levels.
breast milk jaundice
first 4 to 7 days of life but may not peak until about 10 to 14 days. last up to 12 weeks
β-glucuronidase present in breast milk deconjugates bilirubin in the intestinal tract; the unconjugated bilirubin is then reabsorbed via enterohepatic circulation.
benefits of breastfeeding for infant
Maternal-infant bonding
Protection against some infections (e.g. otitis media, respiratory infections, diarrhea)
Reduced rates of Sudden Infant Death Syndrome
Reduced rates of some allergic reactions
benefits of breastfeeding for mom
Decreased postpartum bleeding and more rapid uterine involution
Lactational amenorrhea and delayed resumption of ovulation with increased child spacing
Earlier return to pre-pregnant weight (compared with women who formula-feed)
Improved bone remineralization postpartum with reduction in hip fractures in the postmenopausal period
Decreased cost, relative to formula
Ready availability without preparation time
biliary atresia treatment
Kasai procedure (anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine).
when would you suspect biliary atresia
A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between 3 and 6 weeks of age may have biliary atresia.
urination in first few days
Day 3: voiding 3-4 times a day.
Day 6: at least 6-8 times a day.
Urine should be pale yellow.
stool in first few days
Day 1-3: meconium- dark black
Day 3: yellow.
Day 6 or 7: 3-4 stools per day, or with every feeding.
management of breastmilk jaundice
temporary cessation of breastfeeding (for 24-48 hours) if breast milk jaundice causes extremely high bilirubin levels.
otherwise continue and recheck bill in 24 hrs
Nl weight loss in newborn in first few days
Breastfed infants may lose up to 7%-10% of their birth weight during the first 4 to 5 days of life, and typically regain birth weight by at least 2 weeks of age
