Acute Disease in Children Flashcards
Unconjugated bilirubin is a direct result of
hemoglobin breakdown
Bilirubin binds to ______ which brings it to the _____
albumin, liver
the liver turns unconjugated bilirubin into?
conjugated
conjugated bilirubin is excreted how?
through the stool
Babies with immature livers contain on ____% of the enzymes needed to convert unconjugated to conjugated
1%
Pre term Babies livers contain on ____% of the enzymes needed to convert unconjugated to conjugated
10
In the first week of life, ____ of full term and ____ of preterm infants have jaundice
60%, 80%
physiologic jaundice
normal breakdown of RBC that releases bilirubin, and an immature liver
Pathologic jaundice
any jaundice within the first 24 hours after birth
If TSB rises more than ____mg/dl/day or is higher than ____mg/dl in full term infant or ___-____ for preterm, they need further eval
5
12
10-14
etiology of pathologic jaundice
breast feeding difficulties, dehydration, weight loss, hemolytic anemia, RH incompatibility, certain maternal drugs, metabolic and endocrine disorders
Breast milk jaundice mechanism
unknown, thought that it may be a component of breast milk that blocks the protein in infant livers from breaking down bilirubin
Bilirubin induced neurologic dysfunction
Severe TSB >25mg/dl unconjugated bilirubin (unbound to albumin) crosses the blood brain barrier and binds to brain tissue resulting in brain injuries
results of bilirubin induced neurologic dysfunction
disorders in visuocortical pathways causing alteration in sensorineural hearing, proprioception, speech, and language deficits
Acute Bilirubin encephalopathy
may be reversible, three phases: drowsy, high pitched cry and hypotonic, hypertonicity, fever, apnea, twitching, seizures, respiratory failure, death
Chronic bilirubin encephalopathy
chronic, severe, progressive; permanent neuro sequelae such as choreo-athetoid cerebral palsy; upward gaze abnormalities, enamel dysplasia, sensorineural impairement
risk factors of jaundice
GA <36 weeks, low birth weight, suboptimal breast feeding, male infant, delayed cord clamping, birth trauma
maternal: age >25, maternal diabetes, drug use
genetic disease risk factor for jaundice
gilberts syndrome, galactosemia; family history of liver disease and hemolytic disorders
abx, metabolic acidosis
major risk factors for jaundice
predischarge TB in the high risk zone, jaundice observed in first 24 hours, blood group incompatibility, GA 35-36 weeks, siblings receiving phototherapy, cephalohematoma, poor breast feeding, East Asian race
clinical manifestations of hyperbilirubinemia
jaundice on entire body including palm and soles, loss of stool color, weight loss, drowsy infant, pallor, enclosed hemorrhage, bruising, hepatosplenomegaly
Physical exam with hyperbilirubinemia
visible in face, forehead, mucus membranes, appears on the trunk, hypotonia (mild), hepatosplenomegaly, petechiae, microcephaly
jaundice below ____ ___ is indicative of high bilirubin level
nipple line; indicates bilirubin over 12
DD for infant jaundice
breast milk jaundice, cholestasis, Dubin-Johnson syndrome, glacatosemia, hemolytic disease in newborn, hep B, biliary atresia, duodenal atresia, hypothyroidism
What do you use to determine the risk for jaundice?
bilitool; based on how old they are in hours and what their serum total bili is; helps direct next steps