Hyperbilirubinemia and Hypoglycemia Flashcards

1
Q

majority of newborns with physiologic jaundice demonstrate ______________ within the first ____ days of life

A

yellowish skin, mucous membranes, and sclera within the first 3 days of life

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2
Q

primary mechanism of physiologic jaundice

A

increase RBC volume + short RBC life span = RBC hemolysis after birth = bilirubin load

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3
Q

byproduct of breaking down RBC is

A

bilirubin

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4
Q

the yellowish discolouration of the skin is caused by

A

bilirubin accumulating in the blood

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5
Q

jaundice can be detected by blanching the skin which is done by

A

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

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6
Q

when imbalance is significantly high it can result in

A

acute neurologic sequelae (acute bilirubin encephalopathy)

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7
Q

acute bilirubin encephalopathy is also called

A

kernicterus

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8
Q

neurological effects of unconjugated bilirubin in brain have the pathological finding of

A

deep-yellow staining of neurons and neuronal necrosis of the basal ganglia and brainstem nuclei

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9
Q

new born jaundice is one of the most common reasons for hospital readmission and occurs in ______% of newborns

A

60-80%

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10
Q

phototherapy is indicated when

A

levels of unconjugated serum bilirubin increase and do not return to normal levels with increased hydration

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11
Q

phototherapy is often begun when bilirubin reaches _____ in first 48hrs of life in a term newborn

A

12-14 mg/dL

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12
Q

phototherapy reduces bilirubin levels by

A

breaking down unconjugated bilirubin deposits on skin

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13
Q

measures parents can take to reduce risk of jaundice

A
  • 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
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14
Q

unconjugated bilirubin is

A

fat soluble and toxic to body tissues

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15
Q

conjugated bilirubin is

A

water soluble and non-toxic

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16
Q

only ______ bilirubin can be excreted; mainly through ________

A

conjugated; stool

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17
Q

severe hyperbilirubinemia is total serum bilirubin above ________ at any time during first ____ days of life

A

340 umol/L at any time during first 28 days of life

18
Q

critical hyperbilirubinemia is total serum bilirubin greater than _______ during the first _____ days of life

A

425 umol/L during the first 28 days of life

19
Q

pathologic jaundice means something else is going on before 24 hrs of age and can include . . .

A
  • 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
20
Q

S/S that require investigation

A
  • 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
21
Q

jaundice that occurs after 24 hrs is

A

physiological

22
Q

jaundice that occurs before 24 hrs is

A

pathological

23
Q

Rh incompatibility is a problem when

A

mom is Rh negative and baby is Rh positive

24
Q

Win Rho is given when

A
  • there is mixing of maternal and fetal blood
  • all Rh negative moms get a dose of Win Rho around 20 weeks gestation - given prophylactically
25
Q

Win Rho works by

A

giving mom anti d antibodies that suppress moms’ immune system

26
Q

if no mom had no prenatal care and is Rh- with Rh+ baby Win Rho can still be given within ____ hrs after birth

A

72 hrs

27
Q

there is no need for win rho in a Rh negative mom only when

A

baby is also Rh negative

28
Q

only Rh negative moms need win rho because they don’t have the ___________ that Rh positive moms have

A

antigen

29
Q

ABO incompatibility happens when

A

mom has O blood and baby has A or B or combination of AB blood

30
Q

check newborns for blood antibodies with a _______ test

A

direct antibody test (DAT)

31
Q

if newborn has antibodies in blood there DAT test will come back

A

positive

32
Q

positive DAT in newborns puts them at higher risk for

A

jaundice

33
Q

Kleihauer-Betke is a test that looks for

A

fetal blood cells in maternal system

34
Q

hypoglycemia in newborns is blood glucose less than

A

2.6mmol/L

35
Q

in newborns blood glucose falls to a low point during the first few hours of life because

A

the source of glucose is removed when the placenta is expelled

36
Q

risk factors for hypoglycemia in newborns are

A
  • diabetic mother
  • preterm
  • IUGR (intrauterine growth restriction)
  • SGA
  • poor intake
  • sepsis
  • asphyxia
  • hypothermia
  • polycythemia
  • glycogen storage disorders
  • endocrine deficiencies
37
Q

most newborns experience transient hypoglycemia and are ________

A

asymptomatic

38
Q

when symptoms do show in newborn hypoglycemia they include

A
  • jitteriness
  • lethargy
  • cyanosis
  • seizures
  • high pitched / weak cry
  • hypothermia
  • poor feeding
39
Q

treatment of hypoglycemia in newborns includes

A

administer rapid acting source of glucose
- dextrose gel
- expressed breastmilk and breastfeeding
- formula feeding

40
Q

dextrose gel goes inside the ______ and then should be followed by _______

A

inside the cheek and then should be followed by feeding

41
Q

in sever cases __________ may be required if oral feedings are not effective

A

IV dextrose

42
Q

prevent hypoglycemia in newborns at risk by

A

initiating feedings within the first 30 to 60 minutes after birth