Hypoglycemia and Hyperbilirubinemia Flashcards
When is the lowest glucose level after birth?
2 hours old
Neurogenic symptoms of hypoglycemia
- Adrenergic (jitteriness/tremors, irritability, tachypnea, pallor)
- Cholinergic (sweating, huger, parenthesis)
Neuroglycopenic symptoms of hypoglycemia
Poor suck Poor feeding Weak or high pitched cry Change in level of consciousness (sleepy, lethargy, coma) Seizures Hypotonia
4 non specific findings of hypoglycemia
Apnea
Bradycardia
Cyanosis
Hypothermia
When do we screen glucose levels in infants?
Asymptomatic at risk infants may be measured at 2h and 6 hours
Symptomatic infants should be treated for glucose < 2.6
Routine screening of AGA, at term, health and able to stay with their mother is not recommended
How do you replace glucose when blood sugar is between 1.8-2.5?
Enteral supplementation may be used
Less than 1.8 needs IV
Long term consequences of neonatal hypoglycemia
Learning disabilities
CP seizures disorders
Visual impairment
Neurodevelopmental delay
4 critical samples for hypoglycemia
Glucose
Insulin
Cortisol
GH
Management options for hypoglycemia
Feeding (breastfeeding/measured) Dextrose gel IV dextrose Glucagon Dizoxide Glucose polymers
Which form of bilirubin is neurotoxic?
Unconjugated bilirubin
Risk factors for neonatal jaundice
Visible jaundice < 24 hours or before discharge at any age < 38 weeks Previous sibling with severe hyperbilirubinemia Visible bruising Cephalohematoma Male sex Maternal age > 25 Asian or European Dehydration Exclusive or partial breastfeeding
Physiological hyperbilirubinemia
Occurs 2-3 days of life
Pathophys: decreased RBC lifespan, increased RBC mass and breakdown, immaturity of liver conjugation enzymes
Pathological hyperbilirubinemia
< 24 hours of life
> 2 weeks of life
Conjugated hyperbilirubinemia
Excessive rate of rise > 5 mg/dL/24hrs
Main cause of conjugated hyperbilirubinemia to not miss
Biliary atresia
Kernicterus
Deposition of unconjugated bilirubin in brain cells
Early signs: lethargy, poor feeding, loss of moro reflex
Late signs: opisthotonus, bulging fontanelle, twitching and high pitched cry
Prognosis: death, rigidity, movement disorders, low IQ, hearing loss
Treatment of jaundice
Phototherapy Exchange transfusion (if severe)
Phototherapy for jaundice
Blue green light most effective
Configurational and structural isomers are more lipophilic than normal bilirubin and can be excreted in the bile without glucuronidation in the liver
Photooxidation products are excreted mainly in the urine
Exchange transfusion for jaundice
Involves slowly removing the baby’s blood and replacing it with fresh donor blood
Complications: lyte abnormalities, blood clots, infection, heart and lung problems, shock
