Hyperbilirubinemia 2018 Flashcards
Acute bilirubin encephalopathy symptoms
Severe hyperbilirubinemia
Lethargy
Hypotonia
Poor suck
May progress to hypertonia with a high pitched cry and fever
Can eventually progress to seizures and coma
Chronic bilirubin encephalopathy definition and symptoms
Clinical sequelae of acute encephalopathy
With athetoid cerebral palsy with or without seizures, developmental delay, hearing deficit, oculomotor disturbances, dental dysplasia and mental deficiency
TSB cutoffs for
- Severe hyperbilirubinemia
- Critical hyperbilirubinemia
- > 340 umol/L at any time during the first 28 days of life
2. >435 umol/L during the first 28 days of life
Factors that increase the risk of acute encephalopathy in the presence of severe hyperbilirubinemia
Dehydration hyperosmolarity Respiratory distress Hydrops Prematurity Acidosis Hypoalbuminemia Hypoxia Seizures
Risk factors for hyperbilirubinemia
Visible jaundice <38 weeks gestation Previous sibling with severe hyperbili Visible bruising Cephalematoma Male Maternal age >25 Asian or European Dehydration Exclusive and partial breastfeeding (unclear)
Which jaundiced infants should have a DAT done?
Clinically jaundiced
Mothers are group O
When should TSB or TcB concentration be measured?
Between 24 and 72 hours of life in all infants
3 zones of risk assessment for newborn bili assessment
- Greater than 37 weeks gestation and DAT negative
- 35 to 37 6/7 gestation or DAT positive
- 35 to 37 6/7 gesation and DAT positive
2 factors that make TcB unreliable
After initiation of phototherapy
With changes in skin colour or thickness
3 conditions that cause elevated conjugated bilirubin
Rhesus erythroblastosis
Liver disease
Cholestasis
How does phototherapy work?
Energy from the light induces a conformational change in the bilirubin, making it water soluble
Effectiveness is related to the area of skin exposed and intensity of light at the relevant wavelengths
Bili levels should be checked within 2 to 6 hours of initiation to confirm response
Side effects of phototherapy
Temperature instability Intestinal hypermotility Diarrhea Interference with maternal interaction Bronze discolouration of skin
How does IVIG work for hyperbilirubinemia?
Competitive inhibitor for antibodies that cause red cell destruction
What type of hearing screen should be done on infants with severe hyperbili?
Brainstem auditory evoked potentials
