CBL 9: Formula Feeding, Physiological Jaundice, Newborn Growth

Question 1

How common is physiological jaundice?

Answer 1

60 % of all babes

Question 2

How many infants get severe hyperbili?

Answer 2

2 % of those 60 % with hyperbili

Question 3

Give a succinct definition of jaundice:

Answer 3

*Jaundice is the yellow discoloration of skin and sclera caused by raised levels of bilirubin in the blood.
*It is either physiological or pathological.
*Physiological jaundice is a normal transitional state of the newborn d/t normal physiological process of red cell breakdown following birth.

Question 4

What is the life span of fetal RBC?

Answer 4

80 days

Question 5

What is the life span of extra-uterine RBC?

Answer 5

120 days

Question 6

d) What is the time period of physiological jaundice?

Answer 6

(a) starts after 24 hours; (b) Peaks at 4-5 days, starts in the head, moves down, then back up toward the head (c) can last for a week or two

Question 7

Prevention of physiological jaundice?

Answer 7

Bilirubin excreted through feces, so more input will = more output.

FEED THE BB.

Question 8

Standard treatment of hyperbilirubinemia?

Answer 8

Phototherapy and adequate feeding

Question 9

What are risk factors for severe hyperbilirubinemia? (11)

Answer 9

● Visible jaundice less than 24 hours
● Preterm
● G-6-PD (prevalent in Mediterranean descent among others)
● Male
● Asian ethnicity
● ABO isoimmunization (O birthing person)
● Maternal age greater than 25
● BF
● Dehydration
● Babe significantly bruised following birth
● Babe born to a family with a history of previous children with severe hyperbilirubinemia requiring treatment

Question 10

What is TCB?

Answer 10

Transcutaneous Bilirubin Testing.

Use of a bilimetre (light metre) to screen for jaundice. Non-invasive, pain-free, simple bilirubin measurement tool to help categorize the level of jaundice in the newborn. First 72 hours of life. Screening tool.

Question 11

What is TSB?

Answer 11

total serum bilirubin
Consists of collecting blood via a capillary heel blood sample to determine the amount of bilirubin circulating in blood.
24-72 hours.
Precise bili levels

Question 12

Normal birth weight?

Answer 12

2500-4000 grams

Question 13

Signs of dehydration? (9)

Answer 13

Less output
weight loss greater than 10-15 %
dry mucous membranes
poor turgor
sunken fontanelles
lethargic
infrequent feedings
flexed body
weak or high pitched cry

Question 14

Output for first week?

Answer 14

VOIDs: day 1:1, day 2:2, day 3:3, day 4:4, day 5,6,7:5
SOILED: day 1-2: 1-2; day 3-4: 2-3 brown, green, yellow; day 5,6,7: 2-3 soft/yellow

Question 15

Output 2-3 weeks?

Answer 15

VOIDs: 2-3 (or more) soft and yellow
SOILED: At least 6 wet

Question 16

Input up to 3 weeks?

Answer 16

BF: 8 or more times per day (1-3 hours, including 2-3 night feeds)

Question 17

Gains 2-3 weeks?

Answer 17

120-240 g per week OR 4-8 ounces per week

Question 18

When have newborns typically lost most weight?

Answer 18

Day 3

Question 19

When should bb be back to their birth weight?

Answer 19

No later than 3 weeks

Question 20

How much should nbs gain after their initial weight loss?

Answer 20

15-30 g OR 0.5-1 ounce A DAY

Question 21

Why do nbs lose weight initially?

Answer 21

Colostrum is low in fat and calories. Start to break down the extra fat stored in utero.

Question 22

How much will nbs grow in lengthin 6 weeks?

Answer 22

6 cm in length

Question 23

How much will head circumference increase in 6 weeks?

Answer 23

At least 4 cm

Question 24

3 types of formula?

Answer 24

Ready to feed (sterile)
Liquid concentrate (sterile until opened)
Powdered (not-sterile)

Question 25

How can we ensure our wgt measurements are accurate & reliable? (4)

Answer 25

weighing using same electronic scale
zero prior to use
calibrate regularly
‘average wgt’ function useful with ‘wiggly’ babies

Question 26

What should you do to disinfect formula supplies?

Answer 26

Boil for 2 mins

Question 27

What should you do for safe storage of formula? (5)

Answer 27

Keep prepared formula in fridge for max 24 hours
Warm or cold
Check to make sure not too hot
Do not reheat formula or refrigerate partly used bottle
Throw out formula left out for more than 2 hours

Question 28

How much should you formula feed exclusively?

Answer 28

150 mL/kg/day (divided by the number of feedings)

Question 29

How much should you supplement with formula?

Answer 29

50-100 mL/kg/day (divided by number of feedings) – look for hunger cues(!) and weight gain

Question 30

How long EBM room temp?

Answer 30

3-4 hours

Question 31

How long EBM refrigerated?

Answer 31

3-8 days

Question 32

How long EBM freezer?

Answer 32

3-6 months; deep freeze 6-12 months

Question 33

How much vitamin D give to nb?

Answer 33

BF: 400 IU; Northern Communities: 800 IU; formula fed: still supplement with darker skin, live in communities where vit d deficiency is common

Question 34

What is PURPLE crying?

Answer 34

Peak of crying (most in mo 2, less in mo 3-5)
Unexpected (WHYYY??)
Resists Soothing
Pain-like face (even when they are not in pain)
Long Lasting
Evening

Question 35

Describe vaccines/timelines for first year of life? (6)+ 4

Answer 35

DTap-HB-IPV-Hib – 2 mo, 4 mo, 6 mo
diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib), and hepatitis B
Pneumococcal conjugate(pneomonia) – 2 mo, 3 mo, 12 mo
Rotavirus – 2 mo, 4 mo
Meningococcal conjugate (meningitus) – 2 mo, 12 mo
Influenza/Covid – yearly

Question 36

Levels for severe hyperbilirubinemia?

Answer 36

a total serum bilirubin (TSB) concentration greater than 340 µmol/L at any time during the first 28 days of life

Question 37

Why does physiological jaundice happen?

Answer 37

1) Fetal RBCs shorter lifespan make more bilirubin in body
2) Immature conjunction of bili (in liver) and therefore immature excretion leads to
PHYSIOLOGICAL JAUNDICE

Question 38

What is bilirubin?

Answer 38

A waste product from the breakdown on rbcs.