Hyperbilirubinemia and Hypoglycemia Flashcards
majority of newborns with physiologic jaundice demonstrate ______________ within the first ____ days of life
yellowish skin, mucous membranes, and sclera within the first 3 days of life
primary mechanism of physiologic jaundice
increase RBC volume + short RBC life span = RBC hemolysis after birth = bilirubin load
byproduct of breaking down RBC is
bilirubin
the yellowish discolouration of the skin is caused by
bilirubin accumulating in the blood
jaundice can be detected by blanching the skin which is done by
pressure on the bridge if nose, sternum, or forehead revealing the underlying colour of skin and subcutaneous tissue - is jaundice is present the blanched area will appear yellow before the cap refill
when imbalance is significantly high it can result in
acute neurologic sequelae (acute bilirubin encephalopathy)
acute bilirubin encephalopathy is also called
kernicterus
neurological effects of unconjugated bilirubin in brain have the pathological finding of
deep-yellow staining of neurons and neuronal necrosis of the basal ganglia and brainstem nuclei
new born jaundice is one of the most common reasons for hospital readmission and occurs in ______% of newborns
60-80%
phototherapy is indicated when
levels of unconjugated serum bilirubin increase and do not return to normal levels with increased hydration
phototherapy is often begun when bilirubin reaches _____ in first 48hrs of life in a term newborn
12-14 mg/dL
phototherapy reduces bilirubin levels by
breaking down unconjugated bilirubin deposits on skin
measures parents can take to reduce risk of jaundice
- exposing newborn to natural sunlight for short periods of time to help oxidize the bilirubin deposits on skin
- BF on demand to promote elimination
- avoid glucose and water supplementation, this hinders elimination
unconjugated bilirubin is
fat soluble and toxic to body tissues
conjugated bilirubin is
water soluble and non-toxic
only ______ bilirubin can be excreted; mainly through ________
conjugated; stool
severe hyperbilirubinemia is total serum bilirubin above ________ at any time during first ____ days of life
340 umol/L at any time during first 28 days of life
critical hyperbilirubinemia is total serum bilirubin greater than _______ during the first _____ days of life
425 umol/L during the first 28 days of life
pathologic jaundice means something else is going on before 24 hrs of age and can include . . .
- hemolytic disease - mom and babys blood not compatible
- or non-hemolytic disease - extra blood from other sources such as bruising or hematomas
- G6PD deficiency
- decreased bilirubin conjugation
- impaired bilirubin excretion
S/S that require investigation
- early jaundice
- excessive or rapid increase in TSB level
- TSB level not responding to phototherapy
- excessive weight loss
- pallor
- vomiting
- lethargy
- poor feeding
- apnea
- temp instability
- tachypnea
jaundice that occurs after 24 hrs is
physiological
jaundice that occurs before 24 hrs is
pathological
Rh incompatibility is a problem when
mom is Rh negative and baby is Rh positive
Win Rho is given when
- there is mixing of maternal and fetal blood
- all Rh negative moms get a dose of Win Rho around 20 weeks gestation - given prophylactically
Win Rho works by
giving mom anti d antibodies that suppress moms’ immune system
if no mom had no prenatal care and is Rh- with Rh+ baby Win Rho can still be given within ____ hrs after birth
72 hrs
there is no need for win rho in a Rh negative mom only when
baby is also Rh negative
only Rh negative moms need win rho because they don’t have the ___________ that Rh positive moms have
antigen
ABO incompatibility happens when
mom has O blood and baby has A or B or combination of AB blood
check newborns for blood antibodies with a _______ test
direct antibody test (DAT)
if newborn has antibodies in blood there DAT test will come back
positive
positive DAT in newborns puts them at higher risk for
jaundice
Kleihauer-Betke is a test that looks for
fetal blood cells in maternal system
hypoglycemia in newborns is blood glucose less than
2.6mmol/L
in newborns blood glucose falls to a low point during the first few hours of life because
the source of glucose is removed when the placenta is expelled
risk factors for hypoglycemia in newborns are
- diabetic mother
- preterm
- IUGR (intrauterine growth restriction)
- SGA
- poor intake
- sepsis
- asphyxia
- hypothermia
- polycythemia
- glycogen storage disorders
- endocrine deficiencies
most newborns experience transient hypoglycemia and are ________
asymptomatic
when symptoms do show in newborn hypoglycemia they include
- jitteriness
- lethargy
- cyanosis
- seizures
- high pitched / weak cry
- hypothermia
- poor feeding
treatment of hypoglycemia in newborns includes
administer rapid acting source of glucose
- dextrose gel
- expressed breastmilk and breastfeeding
- formula feeding
dextrose gel goes inside the ______ and then should be followed by _______
inside the cheek and then should be followed by feeding
in sever cases __________ may be required if oral feedings are not effective
IV dextrose
prevent hypoglycemia in newborns at risk by
initiating feedings within the first 30 to 60 minutes after birth
