Hyperbilirubinemia Flashcards
How is bilirubin produced?
produced from the breakdown of heme-containing proteins
-75% from erythrocyte HGB breakdown, 25% from other protein breakdown
bilirubin found in amniotic fluid is concerning for what?
- some bilirubin is normal
- increased amounts concerning for hemolytic disease or intestinal obstruction
what are other properties of bilirubin?
- potent antioxidant
- protection from oxygen see radicals
what drugs knock bilirubin off albumin?
- salicylates, sulfonamides, sodium benzoate
- AMPICILLIN
- INDOMETHACIN
other conditions that can knock bilirubin off albumin?
- hypoxia, acidosis
- hypothermia
- infection
- free fatty acids (IL, starvation)
at what level is hyperbilirubinemia visually apparent?
-when levels are > 5-7 mg/dL
what can cause hyperbilirubinemia in the first 24 hours of life?
- hemolytic disease
- congenital infection
- polycythemia
when does physiologic jaundice peak?
- DOL 3 in term
- DOL 5 to 6 in preterm
definition of pathologic jaundice
any of the following criteria:
- appears in 1st 24 hours of life
- increasing level > 5 mg/dL/d
- level > 12.9 mg/dL in term or >15 mg/dL in preterm
- lasts longer than 1 week in term or longer than 2 weeks in preterm
if a baby is jaundiced longer than you think they should be, then check these two conditions:
- hypothyroidism
- hypopituiarism
what is the recommended follow-up after discharge for hyperbili?
-the rule of 2s: within 2 days, within 2 weeks
describe breast milk jaundice
- late onset, DOL 4-7
- incidence 10-30% from 2-6 weeks of life
- levels 12-20 mg/dL for up to 8 weeks
- caused by ingredients in breast milk
describe breast feeding jaundice
- early onset, DOL 2-4
- caused by inadequate frequency and/or intake of milk
- prevention with frequent breast feeding 8-12 times/day until milk supply established
Treatment of breast milk/feeding jaundice (AAP)
- interruption of breast feeding not encouraged in healthy infants
- levels should decrease by 72 hours, if not, must look for other causes
Which population is at the greatest risk for kernicterus?
late preterm infant
poor feeding potential, decreased BBB, discharged early
chronic problems from kernicterus?
- hearing loss
- cerebral palsy
- gaze abnormalities
- intellectual deficits
describe the initial phase of kernicterus
- slight stupor/lethargy
- hypotonia
- paucity of movement
- poor suck
- high pitched cry
describe the intermediate phase of kernicterus
- moderate stupor
- irritability
- hypertonia
- reverse C shaped arching (retrocollis)
- fever
describe the advanced phase of kernicterus
- deep stupor to coma
- pronounced retrocollis
- no feeding
What bili level is diagnostic of direct hyperbili?
> 2 mg/dL
What can cause direct hyperbilirubinemia?
- liver cell injury (TPN cholestasis, infection, drugs)
- bile flow obstruction (biliary atresia, etc.)
- excessive bilirubin load (maternal/fetal blood group incompatibility)
When should drugs be started for direct hyperbili?
when level is > 2 mg/dL
