EXAM #3: NEONATAL JAUNDICE Flashcards
What is the definition of direct hyperbilirubinemia?
1) Serum conjugated/direct greater than 2 mg/dL
2) Serum conjugated/ direct GREATER THAN 20% OF TOTAL
What does the bilirubin level need to be in the newborn to develop jaudice?
Greater than 5 mg/dL
Where do you look if you’re concerned about cyanosis?
Inside the mouth
List some of the risk factors for jaundice in the newborn.
- Male
- Vacuum/ forceps
- Maternal fever/ GBS
- Maternal DM
- Maternal type O
- Maternal Rh neg
- Siblings with jaundice
- Excessive bruising
- Asian
- Breastfeeding
- PREMATURITY
When does normal jaundice occur?
2nd to 5th day of life
Note that Day 1 jaundice is NOT normal and IS concerning
Why is unconjugated hyperbilirubinemia concerning?
Bilirubin Encephalopathy/Kernicterus
Accumulation of UCB in the basal ganglia*
What is the basis of physiologic jaundice?
- Increased RBCs
- Immature liver/ decreased UGT
UCB gets “stored” in skin and blood as liver catches up*
What is the RBC lifespan in the newborn?
80 days
What labs rule out PHYSIOLOGIC jaundice?
1) UCB greater than 13 in term infant
2) UCB greater than 15 in preterm
3) Increasing more than 5mg/dL in 24 hours
Jaundice in first 24 hours or life
What are some signs of non-physiologic jaundice?
- Pallor or Plethora
- Petechia/ bruising
- Blueberry muffin lesion
- Cataracts
- Goiter
- HSM
- Abnormal tone
- Abdominal mass
What is breastfeeding jaundice?
- Mom not making much milk
- Slight under-nutrition leads to jaundice
What should women be recommended to do when breast-feeding?
Frequent feedings
What is the most common cause of hemolytic disease of the newborn?
ABO incompatibility
Hemolytic anemia increased UCB to liver that the liver can’t handle
How is ABO incompatibility tested for?
Direct Coombs Test
In Rh incompatibility, what does the mother need to be? Baby?
Rh- and baby Rh+ (from Dad)
Note that b/c of immunologic memory, Rh incompatibility leads to worsening of disease
What is Breast Milk Jaundice?
Factor/ long chain fatty acid from breast milk competes with UCB binding to albumin and leads to hyperbilirubinemia
When is Breast Milk Jaundice seen?
- Second week of life
- Breastfeeding well
What do you do for Breast Milk Jaundice?
1) Typically, nothing
2) If high anxiety parent, formula feed for 2 days and then switch back
What drug can be given to treat Crigler-Najar Type II?
Phenobarbital–increases UGT activity
How do we assess for jaundice?
1) Visual–ballpark
2) Bilimeter (placed on skin)
3) Serum bilirubin (heel stick or cord blood)
What are the nomogram risk zones based on?
Levels of bilirubin and HOURS of age
When in the nomogram do you need to follow-up early?
1) High risk= 24 hours
2) Low to high–intermediate= 2-3 days
How do you know when to start phototherapy?
Phototherapy nomogram
What is phototherapy?
Irradiance with blue-green/ 430-490nm light
Makes the UCB more water-soluble*
What are the risks of Phototherapy?
1) Retinal degeneration (cover eyes)
2) Increased insensible fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria
What causes Bronze Baby Syndrome?
Treatment of CB with phototherapy
What do you do if phototherapy is failing to control a rising bilirubin?
Exchange Transfusion (nomogram)
