Block 3 Pediatrics Flashcards
Cause of blue sclera
Osteogenesis imperfecta
Name of cyst along scm in neck
Brachial cleft cyst
Name of cyst in midline of neck
Thyroglossal duct cyst
Breathing difficulty and chest retractions
Mild difficulty: subcostal, substernal
Moderate difficulty: plus intercostal
Severe: plus supraclavicular and suprasternal
Possible Dx in neonate with respiratory distress and flat abdomen
Diaphragmatic hernia
Normal blood vessels in umbilical cord
One vein two arteries
What MSK deformities of the extremities should be evaluated at different ages?
Hip dislocation in infants
Scoliosis in adolescents
Joint integrity in athletes
How do DTRs change with upper and lower motor neuron lesions?
LMN have decreased responses
UMN have increased response
What DTRs can be checked in a newborn?
Chin
Biceps
Brachioradialis
Patellar
What is altitudinal dissociation in terms of reflexes?
Finding at what level reflexes are present vs absent can give an idea where a lesion might be
What superficial reflexes are present in a newborn?
Abdominal
Cremasteric
Anal wink
Babinski
Where are developmental reflexes mediated?
Brainstem or spinal cord
Moro reflex
Infant abducts arms and extends elbows when head is dropped
Appears starting 32 weeks gestation
Well established by 37 weeks gestation
Absent after 3-6 months
Stepping reflex
Starting 32 weeks gone by 1-2 months
Hold infant vertically with feet on flat surface and child does slow stepping motions
Palmar and plantar grasp reflex
Starts 32 weeks, gone 3 months
Absence of plantar grasp in term infant associated with increased risk of cerebral palsy
Asymmetric tonic neck reflex
Turn baby’s head to side and causes fencing posture
Never normal if seen as a resting posture
Present after 35 weeks, established by 1 month postnatal, gone by 3-4 months
What are two components of the Neonatal Behavioral Assessment Scale that are commonly used? Describe them.
Consolability: using different techniques, crying child should be consolable within 15 seconds, abnormal is sign of brain injury
Habituation: child should respond less and less to stimuli such as light in eyes or clapping hands, abnormal sign of prenatal substance abuse exposure indicating cortical damage
In Cystic Fibrosis, what is common cause of pneumonia?
Under 20y staff aureus
Over 20 pseudomonas
Phenergan
Promethazine
Used for motion sickness, pre and post operative sedation, obstetric sedation
Demerol
Meperidine
Opioid analgesic
Can be used for labor
Narcan
Naloxone
Used to reverse opioid effects
How long are infants obligate nose breathers?
First four weeks of life. Possible for kids to be pink when crying but blue when calm because of nasal occlusion. They can only breath through mouth when crying.
Choanal Atresia
Blocking of the choana which are the posterior nasal passages
Failed recanalization during fetal development
What is the criteria for fetal macrosomia?
Birth weight over 8lbs 13oz or 4Kg regardless of gestational age
What is transient tachypnea of the newborn?
Transient tachypnea caused by delayed absorption or clearance of lung fluids after birth in term babies or those at least 35+ weeks
What are risk factors for TTN (transient tachypnea of newborn)?
C-section, male, macrosomia
Long-term outlook for babies with TTN (transient tachypnea of newborn)?
Benign disease that will resolve on its own
Will not recur
Not shown to predispose to any conditions later in life
What test could be done to help confirm TTN (transient tachypnea of newborn) and what findings would it show?
CXR: hyperinflation of the lungs including prominent vascular markings and flattening of the diaphragm with signs of fluid accumulation–fluffy densities representing fluid filled alveoli, fluid between lobes (fissures) and in the pleural space, perihilar streaking representing interstitial fluid and engorged lymphatics
What are some conditions that should be considered in an infant of a diabetic mother?
Most common complication is neonatal hypoglycemia.
Hyperglycemia in the mother early in gestation causes birth defects like neural tube defects. High sugar leads to hyperinsulinemia causing glycogen deposition in liver, heart, kidney, muscles. Large shoulders and abdomen lead to difficult delivery causing shoulder dystocia, clavicle fracture, brachial plexus injury.
Infants born to adolescent mothers are at a greater risk of what?
Low birth weight
Vertical transmission of STI’s
Poorer development outcomes
Increased risk of fetal death
In addition, the mothers are at a greater risk of premature death as compared to their non-pregnant peers.
What are the 3 leading causes of death in adolescents?
Accidents, Homicide, Suicide
What interview technique should be used with all adolescent patients to assess risk-taking behavior?
HEEADSSS assessment which looks for risks leading to accidents, homicide, suicide
What does HEEADSSS stand for?
Home Education/Employment Eating disorder Activities/Affiliations/Aspirations Drugs Sexuality Suicide behavior Safety
What are some questions that could accompany the Home aspect of a HEEADSSS assessment?
Who lives with you? Where do you live?
Do you have your own room?
What are relationships like at home?
What do your parents and relatives do for a living?
Have you ever lived outside your home? (ever incarcerated, institutionalized?)
Have you moved recently? Have you ever thought of running away?
Are there any new people in your home environment?
What are some questions that could accompany the Education/Employment aspect of a HEEADSSS assessment?
What are your favorite subjects? Worst subjects?
Have there been any changes in your grades?
Are you in any special programs in school?
Have you repeated any years? Have you failed any classes?
Have you changed schools recently?
Have you been suspended?
Do you have plans for future education and employment?
Are you working now?
How many hours do you work per week?
How are your relations with your teachers or employers?
What are some questions that could accompany the Eating disorder aspect of a HEEADSSS assessment?
Where and with whom do you eat?
What do you eat?
What are some questions that could accompany the Activities/Affiliations/Aspirations aspect of a HEEADSSS assessment?
What do you like to do for fun?
In what activities do you participate in school or outside of school?
Do you participate in any sports or get regular exercise?
Do you attend church or clubs, or take part in projects?
Do you have any hobbies or other home activities?
Do you read for fun: What?
How much TV do you watch weekly? What are your favorite shows?
What music do you like to listen to?
What do you want to do when you grow up?
What are some questions that could accompany the Drugs aspect of a HEEADSSS assessment?
Do any of your friends smoke or use alcohol or other drugs? If the answer is yes, How do you feel about their use?
Have you ever tried cigarettes, alcohol, marijuana or other drugs? Any performance-enhancing substances?
If yes, How much do you use and how often? Do you do this in any particular setting?
Do your family members use drugs, including alcohol and tobacco?
What are some questions that could accompany the Sexuality aspect of a HEEADSSS assessment?
Have you and your parents talked about sex?
Have you ever had a crush on anyone or has anyone ever had a crush on you?
Have you ever had sex?
Have you ever had unwanted or forced sex?
How many partners have you had?
Do you use contraception?
Do you know about sexually transmitted diseases?
Have you ever been pregnant?
What are some questions that could accompany the Suicide behavior aspect of a HEEADSSS assessment?
Do you feel sad or down more than usual?
Do you have trouble getting to sleep?
Have you ever thought that life isn’t worth living?
Have you thought a lot about hurting yourself or someone else?
What are some questions that could accompany the Safety aspect of a HEEADSSS assessment?
Have you ever been seriously injured? How?
Have you ever done anything that you thought was dangerous?
Have you ever ridden with a driver who was drunk or high? When? How often?
Do you use a seat belt in the car?
Is there violence in your home?
Have you every been physically or sexually abused?
In every pregnancy, what is the background risk of a birth defect?
3-5%
Other factors will add to this background risk that is present in all pregnancies.
Smoking and conception
Smoking makes conception more difficult, but these effects appear to decrease if a woman stops smoking.
Smoking and miscarriage
Smoking leads to an increased risk of miscarriage because it affects the blood flow through the placenta.
It also leads to increased risk of ectopic pregnancy.
Smoking and birth defects
Overall, not shown to have a huge risk for birth defects
May be associated with risk for cleft abnormalities especially if there is a Hx in the family
What are the primary adverse effects of smoking during pregnancy?
Risk of low birth weight and prematurity
Placenta previa and placental abruption
Potential increased risk for child to have asthma, bronchitis, and respiratory infections later in life
Should a woman who smokes breast feed?
Smoking while breast feeding can transfer nicotine and other chemicals to the baby.
If mother cannot stop smoking, it is still best for her to breast feed as the benefits of the breast milk outweigh the risks from the smoking.
Recommend not smoking around the child, though.
How much alcohol can be consumed during pregnancy?
There is no safe amount of alcohol consumption during pregnancy.
Studies have consistently shown that heavy and consistent drinking lead to birth defects.
Stopping at any point during the pregnancy will have beneficial effects on the baby.
Alcohol and birth defects
Alcohol causes many birth defects including:
Low birth weight
Small head size
Mental retardation leading to learning and memory difficulties
Higher chance of behavioral problems, not understanding consequences of behaviors, having poor judgment, and difficulty with social relationships
The above are components of FAS and FASD
Why is it not OK to drink alcohol later in pregnancy?
Alcohol affects the brain of the fetus which is developing throughout pregnancy. The body may not be small, but the head still can be.
Alcohol and breastfeeding
Alcohol passes into the milk at a similar concentration to maternal blood. Must wait 2-2.5 hours per drink for the alcohol to leave the milk. May decrease ability to produce milk.
May cause sleep changes in baby, motor development problems and others. However, these have not been well-studied.
Difference between SGA and IUGR
SGA is Dx at birth, either less than 3rd or 10th percentile based on weight depending on source
IUGR is Dx during pregnancy and is can be due to one or more causative factors
What are the TORCH infections?
Infections that can be transmitted in utero via placenta
T: Toxoplasmosis
O: Other (HIV, Hep B, HPV, Syphilis, Parvovirus, VZV)
R: Rubella
C: Cytomegalovirus
H: HSV 2
What are some maternal factors that can lead to limited fetal growth in utero?
Small or slender mother before conception Young or older mother Poor weight gain in last trimester Peeclampsia Prescription or other drug use Maternal infections Uterine abnormalities
What are some placental abnormalities that can lead to fetal growth restriction in utero?
Placenta previa
Placental abruption
Abnormal umbilical vessel insertions
What are some fetal abnormalities leading to restricted fetal growth in utero?
Fetal malformations
Metabolic disease
Chromosome disorders
Congenital infections
What labs are generally included in a prenatal lab screening?
Serologic testing for HIV, Rubella, Hep B
Blood type and Rh
UDS
What is Rh factor?
A group of proteins on the surface of blood cells that are second in importance to ABO type cells among a list of 35 groups of proteins on RBCs.
In the Rh group, there are 50 proteins among which D is the most important and this is what is checked when they say cells are Rh factor +/-.
Explain the ABO blood system
Most important group of proteins on the surface of RBCs, platelets, endothelium, and other cells. Can also cause complications with organ transplantation.
The associated antibodies are usually IgM and are produced in first years of life by sensitization to environmental substances like food, bacteria, and viruses.
What factors increase the risk of HIV transfer to infant?
High viral load from advanced disease
Frequent unprotected sex during pregnancy which can lead to chorioamnionitis and STI’s which all lead to increased risk of transmission
Vaginal delivery
Breast feeding
Rupture of membranes greater than 4 hours before delivery especially when mother is not on antiretroviral therapy
Delivery before 37 weeks gestation
What is group B strep?
Strep. agalactiae
What is the leading cause of early onset (1st week of life) sepsis and meningitis? What is the most important risk factor? What is the treatment?
Group B strep
Risk factor: mother colonization (about 10-30% of women)
Intrapartum antibiotics very effective in decreasing transmission
When should a mother be given intrapartum antibiotic prophylaxis to prevent GBS transmission?
Gestation of
If a mother tests positive for HIV, what steps should be taken to prevent transmission to the infant?
Treatment of the mother with combination antiretroviral therapy (if viral load > 1000 copies/mL)
When possible, a cesarean delivery should be performed prior to the onset of labor (at 38 weeks’ gestation) and the rupture of membranes.
In the U.S. and other developed nations where alternative sources of feeding are readily available, affordable, and are mixed with clean water, HIV-infected women should be counseled not to breastfeed their infants.
Explain APGAR score
A: Appearance (skin color) P: Pulse G: Grimace A: Activity (muscle tone) R: Respiration
Each category score from 0-2 for total score of 0-10, 3 or lower is critically low, 4-6 moderate, 7-10 normal
Its purpose is to assess child’s need for medical care and not a as a predictor of future problems
What is the word for cyanosis of the hands and feet?
Acrocyanosis
What are the signs of a newborn in respiratory distress?
Apnea
Poor respiratory effort
Tachypnea (rapid respiratory rate): A normal newborn’s respiratory rate will be in the 30s to 50s.
Nasal flaring
Chest wall retractions: Retractions are observed when the skin over the chest wall is “sucking in”; this is usually noted as intercostal (between the ribs), suprasternal (above the sternum) or subcostal (below the ribcage) retractions.
Grunting; Grunting is a noise that is heard on expiration when an infant in respiratory distress is working to keep his or her alveoli open to increase oxygenation and/or ventilation.
Symmetric vs Asymmetric IUGR
Symmetric has equal decrease in length, weight, and head circumference
Asymmetric spares the head circumference while everything else is decreased
An infant born SGA is at risk for what other conditions?
Hypothermia
Hypoglycemia
Polycythemia
What are the anatomical planes of the body?
Frontal/Coronal plane divides ventral from dorsal
Sagittal plane divides left from right
Transverse plane divides upper from lower
What are the sutures on the skull?
Frontal/Metopic: down the frontal bone, fuses by 3-9 months of age
Sagittal: separates left front right
Coronal: separates front to back
Lambdoid: runs left to right on the posterior aspect of the skull
Where is nasion?
The depressed area just above the bridge of the nose where the frontal bone meets the nasal bones
Where is the glabella?
Just superior to nasion between the eyebrows
Where is bregma?
Same point as the anterior fontanelle in infancy
Intersection of coronal and sagittal sutures
When does the fontanelles fuse in the skull?
Posterior and lateral fontanelles fuse by around 6 months
Anterior fontanelle is not completely closed until about the middle of the second year, full ossification starts in late twenties and finishes by age 50
What tests are performed to test for developmental dysplasia of the hip?
Barlow maneuver to dislocate and the Ortolani to put it back
Barlow: Flex hip to 90 degrees and adduct hip with posterior pressure
Ortolani: flex hip to 90 degrees and abduct while pressing anteriorly on the greater trochanter
Why are infants of diabetic mothers at higher risk for RDS?
High insulin levels in the baby interferes with cortisol’s ability to induce surfactant production so the baby can have respiratory difficulty.
Definition of gestational DM?
Fasting glucose over 95mg/dL or above limits of glucose challenge test
Infant Sx of hypoglycemia
Lethargy, listlessness, poor feeding, temperature instability, apnea, cyanosis, jitteriness, tremors, seizures, respiratory distress
Definition of macrosomia
Above 90th percentile for gestational age or over 4kg
Maternal hyperglycemia early in gestation leads to what complications?
Neural tube defects, congenital heart disease, anomalies of the kidneys and skeletal system including caudal regression syndrome
How is hypoglycemia managed in an IDM right after birth?
25-50% of infants will develop hypoglycemia. All should feed within the first hour of life and blood glucose measured 30 min after feeding. Any blood glucose below 40 with symptoms requires IV glucose. If no symptoms, they are re fed and levels measured again at 30 min. Glucose persistently below 25 in first four hours requires IV glucose. Continue monitoring for first 12 hours or until three preprandial are normal.
Besides sugar abnormalities in IDM, what other levels can be off and what are the Sx?
Hypocalcemia is also common in IDM
Sx: irritability, sweating, seizures
Require IV Calcium
What are the different swellings possible on the head of a newborn?
Caput succedaneum: collection of blood just under dermis
Cephalohematoma: blood under periosteum and doesn’t cross suture lines.
How is polycythemia defined in an infant LGA and what are the causes and complications?
Large babies need more oxygen than the placenta can provide so they produce EPO causing polycythemia. After birth, polycythemia causes Hct over 65 making the baby ruddy or plethoric. Leads to increased bilirubin, hyperviscosity syndrome with venous thrombosis in renal veins, cerebral sinus veins, or mesenteric veins.
What perinatal complications should be expected in an infant of a diabetic mother?
Hypoglycemia, polycythemia, hyperbilirubinemia, hypocalcemia, birth trauma
What are the common general findings with TORCH infections?
Microcephaly, Purpuric Rash, HSM
Describe Rubella
“Little Red” in Latin
Known for lacy itchy red rash that starts weeks after exposure on the face and moves to the body. Mild fever, sore throat, fatigue. Adults have joint pain. Rash fades after 3 days. Posterior cervical LAD.
Not significant in most people, problem is Congenital Rubella Syndrome CRS.
CRS: cataracts, deafness, brain, heart problems
Spreads through the air, vaccine very effective, Americas declared free from Rubella transmission in April 2015 by WHO
What is coryza?
Same as rhinitis
Inflammation and irritation of the nasal mucosa leading to stuffiness, runny nose, post-nasal drip
What is Toxoplasmosis?
Parasitic infection acquired by eating poorly cooked food, or exposure to infected cat feces.
In adults, most people will never know they are infected. Some will have flu-like Sx for weeks or months with muscle aches and tender lymph nodes.
About half the world population is infected with it. Up to 20% of American infected.
Can infect any warm-blooded animal, but is only known to replicate in the cat family.
Transferred to infants during pregnancy leading to congenital toxoplasmosis: hydrocephalus, diffuse cerebral calcifications, chorioretinitis.
Tx: pyrimethamine, sulfadiazine, leucovorin for 12 months
How is CMV diagnosed in infants?
Urine culture
What medications or treatments are routinely administered to newborns and why?
Vitamin K to prevent hemorrhagic disease of the newborn
Hep B vaccine
Antibiotic for the eyes to prevent vertical transmission of gonococcal disease
What is the treatment protocol for newborns born to mothers positive for Hep B?
Give them HepB vaccine and immune globulin (HbIG) within 12 hours
CT scan of a child’s head shows calcifications around the ventricles. What is a likely Dx and what would the Dx be if the calcifications were more diffuse?
CMV has calcifications around the ventricles.
Toxoplasmosis has calcifications more diffusely distributed.
What will be seen on a scan of the brain in a child with congenital CMV?
Mineralizing microangiopathy and periventricular cysts
Lissencephaly (decreased number of gyri and thick cortex)
Enlarged ventricles
What is Behçet’s disease?
rare immune-mediated small-vessel systemic vasculitis[2] that often presents with mucous membrane ulceration and ocular problems.
What is the Uvea?
the pigmented middle of the three concentric layers that make up an eye.
What are the 5 W’s of post operative fevers?
Wind: pneumonia, atelectasis @ 1st 24-48hrs
Water: UTI anytime after post op day 3
Wound: wound infections anytime after POD5
Wonder drugs: especially anesthesia
Walking: walking can help reduce DVT and PE usually occur POD 7-10
What is JIA?
Juvenile Idiopathic Arthritis Used to be called Juvenile RA Less than 16yo, over 6 weeks Can be self limited or chronic Unknown cause, inflammatory condition of synovium Most often 7-12yo Majority of cases are RF negative
Sequelae of congenital CMV?
Hearing loss–can show up after the newborn period and is often progressive
Microcephaly and intracranial calcifications: can lead to developmental delay and intellectual disabilities
HSM and rash: will resolve with time
What is the treatment for kids with congenital CMV?
Parenteral ganciclovir or oral valganciclovir for 6 months
Tx has been shown to reduce hearing loss and developmental delay
How often should a mother nurse her baby?
Whenever there are signs of hunger. Usually 8-12 times per day.
Absolute contraindications for breast feeding
Mother has HIV Mother has active, untreated TB Mother has active herpes outbreak on breast Mother is on drug of abuse Infant has galactosemia
Benefits of breast feeding to the child
Stimulates GI growth and motility and maturity
Decreases acute illnesses during period being breast fed
Lower rates of diarrhea, otitis media, andUTI’s
Associated with lower rates of obesity, cancer, CAD, allergies, DM type I, IBD
Better cognitive and motor development
Maternal benefits of breast feeding
Decreased:
Breast cancer
Ovarian cancer
Osteoporosis
How soon after discharge should a newborn baby be re-evaluated and why?
24-48 hrs after discharge to be evaluated for appropriate urine and stool output and weight change
What are some of the diseases screened for in newborns?
PKU, hypothyroidism in all states
Galactosemia, biotinidase deficiency, hemoglobinopathy, maple syrup urine disease, homocysteinuria, congenital adrenal hyperplasia, CF, G6PD, toxoplasmosis
Congenital heart disease and deafness
What could be the adverse effects on an infant of a mother on anticonvulsant medication?
Heart defects, craniofascial abnormalities including microcephaly, hypoplastic nails and distal phalanges, IUGR.
What are the signs of PKU (phenylketonuria)?
Lack of phenylalanin hydroxlase
Vomiting, hypotonia, musty odor to body and urine, developmental delay, decreased pigment in hair and eyes
Features of homocysteinuria
Lacks enzyme cystathionine synthase
Dx by testing for increased methionine in urine or blood
Sx: marfanoid habitus, hypercoaguable state, developmental delay
Niemann-Pick disease
Lack sphingomyelinase causing a lysosomal storage disease
Present by 6m with hepatomegaly, ataxia, seizures, progressive neurological degeneration, fundoscopic exam shows cherry red macula
Hurler syndrome
Lack alpha-L-iduronidase causing lysosomal storage disease
Generally present around 1 year of age
Sx: hepatosplenomegaly, coarse facial features, frontal bossing, corneal clouding, developmental delay
Generally don’t live past 15y
Von Gierke’s disease
Defect in glucose 6 phosphatase causing glycogen storage disease (not the same as G6PD deficiency)
Hepatomegaly, hypoglycemia, metabolic acidosis
Through what process do newborns develop hyperbilirubinemia?
Most of bilirubin in newborns comes from hemolysis
As part of the pathway that removes bilirubin from the system, it is excreted in bile into the intestines where the intestinal flora processes it into urobilin that is lost in the stool.
Newborns don’t have the flora to perform this function, so the conjugated bilirubin becomes unconjugated again and re-enters the blood stream bound to albumin. This is the enterohepatic circulation.
The conversion from conjugated to unconjugated is performed by beta glucuronidase present in the brush border and in breast milk leading to jaundice.
Through what process do newborns develop hyperbilirubinemia?
Most of bilirubin in newborns comes from hemolysis
As part of the pathway that removes bilirubin from the system, it is excreted in bile into the intestines where the intestinal flora processes it into urobilin that is lost in the stool.
Newborns don’t have the flora to perform this function, so the conjugated bilirubin becomes unconjugated again and re-enters the blood stream bound to albumin. This is the enterohepatic circulation
What medication is used to prevent hemolytic disease of the newborn?
RhoGam
Anti-Rh immunoglobulin
What are signs of a newborn severely affected by kernicterus?
Lose suck reflex
Become lethargic
Develop hyperirritability and seizures
Can ultimately die
What are possible sequelae of kids who survive kernicterus?
opisthotonus (abnormal posturing that involves rigidity and severe arching of the back, with the head thrown backward) rigidity oculomotor paralysis tremors hearing loss, and ataxia
Direct vs indirect Coomb’s test
Direct Coombs test is used for autoimmune hemolytic anemia. It tests for autoantibodies and complement that are already bound “directly” to RBC’s. Coomb’s factor is added to washed RBC’s which is anti-human immunoglobulin.
Indirect Coombs test is used prenatally and before transfusions. It tests for the presence of autoantibodies unbound to RBC’s.
Compatibility of RBCs and Plasma in terms of donation to a recipient. (Transfusion)
RBC transfusion: O is the universal donor because the RBCs have on antigens on them to cause a reaction. AB is the universal recipient because the RBCs already have all antigens and therefore there are no antibodies present
Plasma transfusion: Pattern is opposite to RBC transfusion. O is universal recipient because there is nothing for incoming antibodies to react with. But O plasma can only be given to O blood individuals. AB is the universal donor because there are no antibodies present in the serum. AB people can only receive AB serum.
Direct Coombs test and hemolytic disease of the newborn. How good is the test?
The test may often be only slightly positive, or even negative even if there really is a problem. This is because newborn RBCs do not have as many AB binding sites as adult cells. Therefore, HDN may not cause significant jaundice and will only shorten the lifespan of the RBCs minimally.
What blood type combination is classic between mother and baby to cause hemolytic disease of the newborn?
Mother has O blood and the baby has something else. Having O blood means she has all antibodies leading to lysis of infant cells.
What is the normal progression of bilirubin levels in a newborn? Explain why.
Almost all newborns have hyperbilirubinemia. Usually first seen at day 2-3 and peaks at days 3-4.
Newborns have increased bili because:
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).
What is physiologic jaundice?
Bili less than 15 mg/dL in kids that have no other demonstrable cause
Explain jaundice associated with breast feeding.
Two types: breastfeeding jaundice and breast milk jaundice
1) Breastfeeding: (lack of milk jaundice), in first week of life when milk levels are low leading to low enteral intake for the infant causing slow GI movement and delayed passing of meconium. Meconium has beta-glucuronidase which deconjugates bili so it can be reabsorbed into the serum. Difficult to distinguish from physiologic jaundice.
2) Breast milk: develops in first 4 to 7 days of life but may not peak until 10-14 days. Thought to be caused by increased beta-glucuronidase in the milk leading to increased enterohepatic circulation. Can last up to 12 weeks. Bili levels usually don’t get high enough to be concerning.
What are the most common hemolytic causes of jaundice in a newborn?
Rh factor incompatibility
ABO incompatibility
Minor blood group incompatibility
(the above are antibody positive hemolysis)
RBC membrane disorders like spherocytosis or enzyme disorders like G6PD deficiency (these are antibody negative)
