Hyperbilirubinemia

Question 1

What is hyperbilirubinemia?

Answer 1

Elevated total serum bilirubin level

Question 2

What defines hazardous hyperbilirubinemia?

Answer 2

TSB > 30 mg/dL

Question 3

What is bilirubin?

Answer 3

A byproduct of RBC destruction which releases heme-containing proteins

Question 4

What is jaundice?

Answer 4

Yellow color caused by the deposit of bilirubin in the skin

Question 5

What is acute bilirubin encephalopathy?

Answer 5

Bilirubin toxicity with direct correlation to elevated levels of unconjugated bilirubin and symptoms

Question 6

What are the phases of acute bilirubin encephalopathy?

Answer 6

• Phase 1: lethargy, hypotonia
• Phase 2: fever, retrocollis, hypertonia, opisthotonos, high pitched cry
• Phase 3: shrill cry, hearing and visual impairment, athetosis, apnea, seizures, coma, death

Question 7

What is kernicterus?

Answer 7

Irreversible, chronic sequelae of bilirubin toxicity

Question 8

What is unconjugated bilirubin?

Answer 8

Indirect bilirubin, fat soluble, produced by RBC destruction

Question 9

What is conjugated bilirubin?

Answer 9

Direct bilirubin, transformed by liver to water soluble form

Question 10

What is free bilirubin?

Answer 10

Indirect bilirubin which is not bound to albumin

Question 11

What is the normal bilirubin production rate in neonates?

Answer 11

8 – 10 mg/kg/day

Question 12

What is the binding capacity of bilirubin?

Answer 12

Bilirubin binds reversibly to albumin, with each molecule capable of binding ~ 2 molecules of bilirubin

Question 13

What enzyme converts bilirubin in the intestine?

Answer 13

β-glucuronidase

Question 14

What is the significance of G6PD deficiency in hyperbilirubinemia?

Answer 14

Recognized as one of the most important causes of hazardous hyperbilirubinemia in the US and worldwide

Question 15

What are risk factors for developing significant hyperbilirubinemia?

Answer 15

• Lower gestational age
• Jaundice in the first 24 hours after birth
• Family history of phototherapy or exchange transfusion
• Exclusive breastfeeding with suboptimal intake

Question 16

What characterizes physiologic (non-pathologic) jaundice?

Answer 16

• Otherwise healthy infant
• Direct coombs negative
• Develops at > 24 hours of age
• Total bilirubin < 12 mg%

Question 17

What characterizes pathologic or hazardous jaundice?

Answer 17

• Appears at < 24 hours of age (term)
• Persists beyond normal time frame
• Rate of rise > 0.2-0.3 mg% per hour

Question 18

What is RhoGAM?

Answer 18

Anti-D human gamma globulin given to mothers to prevent maternal production of anti-Rh(D) antibodies

Question 19

What is the role of phototherapy in treating hyperbilirubinemia?

Answer 19

Begins based on gestational age, TSB, and presence of neurotoxicity risk factors

Question 20

What are the three types of chemical reactions that occur during phototherapy?

Answer 20

• Photoisomerization
• Structural isomerization
• Photo-oxidation

Question 21

What are the side effects of phototherapy?

Answer 21

• GI hypermotility: loose stools
• Lethargy or irritability

Question 22

What is the recommended feeding support to prevent hyperbilirubinemia?

Answer 22

Exclusive breastfeeding and feeding upon demand at least 8 times in 24 hours

Question 23

What is the significance of bilirubin levels in treatment decisions?

Answer 23

Decisions are guided by gestational age, TSB, and neurotoxicity risk factors

Question 24

What is the purpose of the direct antiglobulin test (DAT)?

Answer 24

To determine if an infant has antibodies that could cause hemolytic disease

Question 25

Fill in the blank: Kernicterus is caused by the transfer of _______ bilirubin into brain cells.

Answer 25

free (unbound and unconjugated)

Question 26

True or False: Phototherapy is ineffective for lowering bilirubin levels.

Answer 26

False

Question 27

What factors can influence bilirubin levels in infants?

Answer 27

* Gestational age * Weight * Infection * Feeding

Question 28

What is essential to ensure for a newborn's health?

Answer 28

Adequate hydration ## Footnote Hydration helps prevent complications related to hyperbilirubinemia.

Question 29

What should be followed to monitor newborn health?

Answer 29

Bilirubin level ## Footnote Monitoring bilirubin levels is crucial in detecting and managing jaundice.

Question 30

What is a recommended practice to protect a newborn's eyes during phototherapy?

Answer 30

Protect eyes with patches ## Footnote Eye protection is necessary to prevent damage from phototherapy lights.

Question 31

What is important to monitor in terms of a newborn's intake?

Answer 31

Weight, voids, stools ## Footnote Monitoring these factors helps assess the newborn's wellbeing and hydration status.

Question 32

What should be avoided when feeding a newborn with jaundice?

Answer 32

Sterile water or glucose water ## Footnote These should not be used as they do not provide adequate nutrition.

Question 33

What are some side effects of phototherapy?

Answer 33

Loose stools, lethargy, retinal damage, photosensitivity ## Footnote These side effects can occur due to the effects of light therapy.

Question 34

When can phototherapy be discontinued?

Answer 34

When TSB has decreased by at least 2 mg/dL below the threshold ## Footnote This is a guideline for safely stopping phototherapy.

Question 35

What is rebound hyperbilirubinemia defined as?

Answer 35

TSB concentration reaching the phototherapy threshold within 72-96 hours after discontinuation ## Footnote Monitoring for rebound is important to prevent complications.

Question 36

What is the escalation of care threshold for bilirubin levels?

Answer 36

2 mg/dL below the exchange transfusion threshold ## Footnote This level indicates a need for urgent medical intervention.

Question 37

What should be done if signs of bilirubin encephalopathy are present?

Answer 37

Urgent exchange transfusion ## Footnote This procedure is critical to prevent permanent damage.

Question 38

What is required for discharge planning for neonates?

Answer 38

Follow-up within 24 to 48 hours after discharge ## Footnote This ensures monitoring of the newborn's health post-discharge.

Question 39

What should be documented at discharge?

Answer 39

Discharge exam, feeding, stooling, instructions ## Footnote Documentation is essential for continuity of care.

Question 40

Fill in the blank: _______ should be consulted for breastfeeding management.

Answer 40

Lactation consult ## Footnote This helps ensure proper feeding practices for jaundiced infants.

Question 41

What should be checked 12-24 hours after discontinuing phototherapy?

Answer 41

Bilirubin levels ## Footnote This helps to assess for any rebound in bilirubin concentration.