EXAM #3: NEONATAL JAUNDICE

Question 1

What is the definition of direct hyperbilirubinemia?

Answer 1

1) Serum conjugated/direct greater than 2 mg/dL

2) Serum conjugated/ direct GREATER THAN 20% OF TOTAL

Question 2

What does the bilirubin level need to be in the newborn to develop jaudice?

Answer 2

Greater than 5 mg/dL

Question 3

Where do you look if you’re concerned about cyanosis?

Answer 3

Inside the mouth

Question 4

List some of the risk factors for jaundice in the newborn.

Answer 4

• Male
• Vacuum/ forceps
• Maternal fever/ GBS
• Maternal DM
• Maternal type O
• Maternal Rh neg
• Siblings with jaundice
• Excessive bruising
• Asian
• Breastfeeding
• PREMATURITY

Question 5

When does normal jaundice occur?

Answer 5

2nd to 5th day of life

Note that Day 1 jaundice is NOT normal and IS concerning

Question 6

Why is unconjugated hyperbilirubinemia concerning?

Answer 6

Bilirubin Encephalopathy/Kernicterus

Accumulation of UCB in the basal ganglia*

Question 7

What is the basis of physiologic jaundice?

Answer 7

• Increased RBCs
• Immature liver/ decreased UGT

UCB gets “stored” in skin and blood as liver catches up*

Question 8

What is the RBC lifespan in the newborn?

Answer 8

80 days

Question 9

What labs rule out PHYSIOLOGIC jaundice?

Answer 9

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

Question 10

What are some signs of non-physiologic jaundice?

Answer 10

• Pallor or Plethora
• Petechia/ bruising
• Blueberry muffin lesion
• Cataracts
• Goiter
• HSM
• Abnormal tone
• Abdominal mass

Question 11

What is breastfeeding jaundice?

Answer 11

• Mom not making much milk

- Slight under-nutrition leads to jaundice

Question 12

What should women be recommended to do when breast-feeding?

Answer 12

Frequent feedings

Question 13

What is the most common cause of hemolytic disease of the newborn?

Answer 13

ABO incompatibility

Hemolytic anemia increased UCB to liver that the liver can’t handle

Question 14

How is ABO incompatibility tested for?

Answer 14

Direct Coombs Test

Question 15

In Rh incompatibility, what does the mother need to be? Baby?

Answer 15

Rh- and baby Rh+ (from Dad)

Note that b/c of immunologic memory, Rh incompatibility leads to worsening of disease

Question 16

What is Breast Milk Jaundice?

Answer 16

Factor/ long chain fatty acid from breast milk competes with UCB binding to albumin and leads to hyperbilirubinemia

Question 17

When is Breast Milk Jaundice seen?

Answer 17

• Second week of life

- Breastfeeding well

Question 18

What do you do for Breast Milk Jaundice?

Answer 18

1) Typically, nothing

2) If high anxiety parent, formula feed for 2 days and then switch back

Question 19

What drug can be given to treat Crigler-Najar Type II?

Answer 19

Phenobarbital–increases UGT activity

Question 20

How do we assess for jaundice?

Answer 20

1) Visual–ballpark
2) Bilimeter (placed on skin)
3) Serum bilirubin (heel stick or cord blood)

Question 21

What are the nomogram risk zones based on?

Answer 21

Levels of bilirubin and HOURS of age

Question 22

When in the nomogram do you need to follow-up early?

Answer 22

1) High risk= 24 hours

2) Low to high–intermediate= 2-3 days

Question 23

How do you know when to start phototherapy?

Answer 23

Phototherapy nomogram

Question 24

What is phototherapy?

Answer 24

Irradiance with blue-green/ 430-490nm light

Makes the UCB more water-soluble*

Question 25

What are the risks of Phototherapy?

Answer 25

1) Retinal degeneration (cover eyes)
2) Increased insensible fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria

Question 26

What causes Bronze Baby Syndrome?

Answer 26

Treatment of CB with phototherapy

Question 27

What do you do if phototherapy is failing to control a rising bilirubin?

Answer 27

Exchange Transfusion (nomogram)