CBL 7 – Jaundice Flashcards
BF for late preterm infant?
Lots of support lol
What are late preterm infants at risk of? (5)
Often have less successful BF rates than term or earlier preterm babes, because they seem sturdy but are actually developmentally immature, so don’t get adequate support
Increased risk for
jaundice
hypoglycemia
slow weight gain
dehydration
formula use
Calculation for feeding baby on feeding plan?
150 mLs per kilo per day /divided by number of feeds (ends up being A LOT)
Define jaundice
Definition: Yellow coloration of sclera and skin due to increased levels of bilirubin (which is a byproduct of red blood cells breaking down) in the bloodstream
Defined physiological jaundice
Normal jaundice with transition from intrauterine to extrauterine life with no adverse sequelae
Usually after 24 hours - 6 days (visible)
Define Pathological Jaundice
When jaundice occurs for reasons other than normal newborn transition and/or when circulating bilirubin levels reach a level of neurotoxicity that result in adverse sequalae
Often within the first 24 hours
Types of pathological hyperbilirubinemia?
Severe and critical
Define severe hyperbilirubinemia
total serum bilirubin (TSB) > 340 μmol/L in first 28 days of life
Define critical hyperbilirubinemia
TSB > 425 μmol/L in first 28 days of life (1)
What numbers are needed for TSB for adverse neurological sequale?
Adverse neurological sequale have not been documented with TSB <340 μmol/L
Adverse neurological sequale are very rare 340 μmol/L to <425 μmol/L, less rare >425 μmol/L
Etiology of Physiological Jaundice
· Newborns have more red blood cells than adults and the fetal red blood cells still circulating have a shorter life span than adult red blood cells, which results in a higher level of red blood cells and then a higher level of bilirubin than adults have (1,2)
· Immature liver that can’t conjugate (process where the liver makes bilirubin water soluble) bilirubin as quickly as adult livers which makes for slower excretion of bilirubin (1,2)
· Conjugated bilirubin is broken down further by bacteria in the gut that newborns aren’t as colonized with, making the excretion slower than in adults (2)
4 main reasons for pathological jaundice?
- Hemolytic
- non hemolytic
- impaired bilirubin conjugation
- impaired bilirubin excretion
Some examples of hemolytic jaundice? (4)
Isoimmunization
RBC enzyme defects
RBC membrane defects
Hemoglobinopathies (thalassemia and sickle cell)
Some examples of non-hemolytic jaundice? (3)
Extravascular blood (hematoma, etc)
Polycythemia (intrauterine hypoxia)
Exaggerated enterohepatic circulation (cystic fibrosis, breastmilk jaundice)
Some examples of impaired bilirubin conjugation? (3)
- Gilbert syndrome – genetic mutation that leads to reduced activity of UDP-glucoronyl transferase (fairly common, 3-7 % incidence) (1)
- Crigler-Najjar syndromes – autosomal recessive genetic mutation reduces levels of UDP-glucoronyl transferase (rare, 0.6 per million) (1)
- Congenital hypothyroidism – decreases bilirubin conjugation and decreases gut motility (1
Some examples of impaired bilirubin excretion? (4)
- Biliary obstruction – biliary atresia (40-50 % of all biliary obstructions), gallstones, bile duct abnormalities (1)
- Infection – examples cholestasis (impaired bile flow between liver and small intestines) from sepsis, meningitis, TORCH infections (1)
- Chromosomal differences – Trisomy 18 and 21, Turner’s syndrome – all have reduction of intrahepatic bile ducts (1)
- Metabolic disorders – causing cholestasis (1)
How long physiological jaundice last?
Sometimes so long, months especially if breastfed
Incidence of jaundice term?
60 %
