jaundice Flashcards
jaundice
unconjugated hyperbilirubinemia can have serious conseq- kernicterus, nuro impairment, brain damage, encephalopathy
bilirubin pthwy
hg –> unconjugated bili= insoluble in aqueous soln –> bind albumin in blood –> liver extract it –> bind cystosolic protein –> conjugated with glcuronide by UDPGT= glycyronosyl transferase –> water soluble –> excrete in bile –> GI (in adult flora convert to urobilin- excrete) in baby no flora –> beta glucuronidase in meconium hydrolyze it back to unconjugated form –> reabsorbed into blood –> bind albumin= enterohepatic circulation
kernicterus
staining of basal ganglia and CN nuclei by bili. result from toxic lvl of UCB. may lose suck reflex, become lethargic, dev hyper irritability and seizure, die. if survive may get opisthotonus, rigidity, oculomotor paralysis, tremors, hearing loss, ataxia.
hemolysis from ph incompatibility. screen decr this.
physiological jaundice
Tbili
jaundice associated with breastfeeding
1) breastfeeding jaundice
2) breast milk jaundice
breastfeeding jaundice aka lack of milk jaundice
1) early in the first week of life and occurs when the milk supply is relatively or absolutely low, resulting in limited enteral intake.
2)The low intake results in decreased gastrointestinal motility that in turn promotes retention of meconium.
3) The β-glucuronidase in meconium deconjugates bilirubin and the unconjugated bilirubin is reabsorbed via the enterohepatic circulation, causing an elevation of serum levels.
4) Breast milk production typically increases greatly once “let-down” occurs.
Occasionally, persistently low volume of breast milk can cause the neonate to become dehydrated and malnourished.
breast milk jaundice
1) Begins in the first 4 to 7 days of life but may not peak until about 10 to 14 days.
2) Not the result of low breast milk volume.
3)While the cause is not completely understood, one explanation is that β-glucuronidase present in breast milk deconjugates bilirubin in the intestinal tract; the unconjugated bilirubin is then reabsorbed via enterohepatic circulation.
4) Breast-milk jaundice can persist for up to 12 weeks, but total bilirubin concentration rarely, if ever, reaches concerning levels.
The time course of breast-milk jaundice is quite different from that of physiologic jaundice.
tx: continue feeding. reck in 24hr
hemolysis
direct coombs- ab pos hymolsysi= direct ab test pos (DAT)
rh incompatibility, ABO incompatibility, incomp minor blood ag, ab neg hemolysis in infant with RC mem defect- spherocyte or G6P dehydrogenase or pyruate kinase def.
other causes of jaundice
non-hemolytic RBC breakdown- bruising from birth trauma, large cephalohematoma or other hemorrhage, polycythemia, swallowed blood during delivery
metabolic error- crippler nadir syndrome, galactosemia and hypothyroidism
etnicicty- asin > caucasian
crigler najjar syndrome
hyperbilirubinemia results from decreased bilirubin clearance caused by deficient or completely absent UDPGT.
nursing
8-12/24hr. 10-15min at each breast.
chart review in jaundice
when jaundice start (by d 4-5 r/o physiological and severe hemolysis). wt hx- if don’t gain- indicate insufficient fluid and calorie intake- dx breastfeeding jaundice
feeding hx
preg hx- maternal infection in utero –> IUGR
illness in newborn- temp instbaility, respiratory distress, apnea, irritability, lethargy, poor tone, vomiting, poor feeding
Glucose 6 phosphate dehydrogenase def (G6PD)
more common in mediterranean. x linked. result in hemolysis and jaundice.
newborn voiding
day 3- 3-4/d
day 6 6-8/d
pale yellow
newborn stool
day 3- meconium stop. bowel mV yellow
6-7: 3-4 stools/d.
if lose color= echoic- sign of biliary atresia
