JAUNDICE Flashcards
MANAGEMENT
HISTORY:
gestational age
maternal labs
pregnancy complications
delivery type and complications
NICU stays
bilirubin levels before discharge
phototherapy
Birth weight
Head circumference
first passed meconium
newborn screens
Feeding: breast vs. formula
Quantity
Frequency
Feeding concerns
Stooling / Voiding
Number of wet diapers per day
Brick dust
Weight Trend
Family History of jaundice / blood disorders, siblings that required phototherapy
EXAM
Things to Look For:
Volume Status
Skin: blanching, jaundice in cephalocaudal pattern
Head: cephalohematoma, caput succedanum
Mouth: jaundice under tongue
Eyes: Scleral icterus
Abdo exam: hepatosplenomegally
Neuro Exam
Pathologic hyperbilirubinemia
Rate of rise >5 mg / dL / day of total serum bilirubin
Hyperbilirubinemia before 24 hrs of life
Conjugate hyperbilirubinemia (>2 mg / dL OR >20% of total serum bilirubin)
DDx: Unconjugated
Sepsis
TORCH
Drugs: Ceftriaxone
Benign Neonatal Hyperbilirubinemia: 24 hr - 5 days
Breastfeeding Jaundice: 1st week of life
Breastmilk Jaundice: after 1st week - 12 weeks
Hemolysis:
-Cephalohematoma
-Caput Succedeneum
-Neonatal polycythemia (maternal diabetes, fetal hypoxia, twin-twin transfusion, delayed cord clamping)
-Maternal-fetal ABO or Rh incompatability
Hypothyroid
Glucose-6-Phosphate dehydrogenase deficiency
Hereditary Spherocytosis
Gilbert
Crigler-Najar
DDx: Conjugated
Biliary Atresia
Choledochal cyst
Alagille Syndrome
Investigations
Transcutaneous Bilirubin Screen
Nonogram
CBC
Blood Type
Coomb’s Test Reticulocytes
LFT’s
PBS
Consider septic workup: U/A, U Clx, Blood Clx, LP, CXR
Abdominal U/S if Conjugated Hyperbilirubinemia
Complications
bilirubin encephalopathy (kernicterus)
