CBL 9: Formula Feeding, Physiological Jaundice, Newborn Growth Flashcards
How common is physiological jaundice?
60 % of all babes
How many infants get severe hyperbili?
2 % of those 60 % with hyperbili
Give a succinct definition of jaundice:
*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.
What is the life span of fetal RBC?
80 days
What is the life span of extra-uterine RBC?
120 days
d) What is the time period of physiological jaundice?
(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
Prevention of physiological jaundice?
Bilirubin excreted through feces, so more input will = more output.
FEED THE BB.
Standard treatment of hyperbilirubinemia?
Phototherapy and adequate feeding
What are risk factors for severe hyperbilirubinemia? (11)
● 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
What is TCB?
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.
What is TSB?
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
Normal birth weight?
2500-4000 grams
Signs of dehydration? (9)
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
Output for first week?
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
Output 2-3 weeks?
VOIDs: 2-3 (or more) soft and yellow
SOILED: At least 6 wet
Input up to 3 weeks?
BF: 8 or more times per day (1-3 hours, including 2-3 night feeds)
Gains 2-3 weeks?
120-240 g per week OR 4-8 ounces per week
When have newborns typically lost most weight?
Day 3
When should bb be back to their birth weight?
No later than 3 weeks
How much should nbs gain after their initial weight loss?
15-30 g OR 0.5-1 ounce A DAY
Why do nbs lose weight initially?
Colostrum is low in fat and calories. Start to break down the extra fat stored in utero.
How much will nbs grow in lengthin 6 weeks?
6 cm in length
How much will head circumference increase in 6 weeks?
At least 4 cm
3 types of formula?
Ready to feed (sterile)
Liquid concentrate (sterile until opened)
Powdered (not-sterile)
How can we ensure our wgt measurements are accurate & reliable? (4)
weighing using same electronic scale
zero prior to use
calibrate regularly
‘average wgt’ function useful with ‘wiggly’ babies
What should you do to disinfect formula supplies?
Boil for 2 mins
What should you do for safe storage of formula? (5)
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
How much should you formula feed exclusively?
150 mL/kg/day (divided by the number of feedings)
How much should you supplement with formula?
50-100 mL/kg/day (divided by number of feedings) – look for hunger cues(!) and weight gain
How long EBM room temp?
3-4 hours
How long EBM refrigerated?
3-8 days
How long EBM freezer?
3-6 months; deep freeze 6-12 months
How much vitamin D give to nb?
BF: 400 IU; Northern Communities: 800 IU; formula fed: still supplement with darker skin, live in communities where vit d deficiency is common
What is PURPLE crying?
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
Describe vaccines/timelines for first year of life? (6)+ 4
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
Levels for severe hyperbilirubinemia?
a total serum bilirubin (TSB) concentration greater than 340 µmol/L at any time during the first 28 days of life
Why does physiological jaundice happen?
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
What is bilirubin?
A waste product from the breakdown on rbcs.
