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Pediatrics > Jaundice > Flashcards

Jaundice Flashcards

1
Q

Interviewing new parents

A
  • offer congrats, comment on growth
  • ask their concerns
  • be aware of baby blues and postpartum depression
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2
Q

Jaundice

A
  • hyperbilirubinemia –> conjugated and unconjugated

- unconjugated causes problems

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3
Q

Newborn bilirubin physiology

A

~75% of bilirubin comes from RBC breakdown
hemoglobin released –> broken down to unconjugated bilirubin –> binds to albumin –> liver conjugates bilirubin with UDPGT –> conjugated excreted into bile and then intestine
Newborns lack GI flora –> bilirubin goes back to unconjugated form –> reabsorbed into blood stream

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4
Q

Kernicterus

A

pathologic term used to describe staining of basal ganglia and CN nuclei (toxic levels of bilirubin)
Sequelae - lose suck reflex, lethargy, seizures, hyperirritability, die
If they survive –> lots of bad things follow
- typically were from Rh incompatibility

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5
Q

Etiologies of Jaundice

A

Physiologic Jaundice
Breastfeeding
Hemolysis
Other

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6
Q

Physiologic Jaundice

A

Total bilirubin

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7
Q

Jaundice with breastfeeding

A

Occurs early when supply is low –> low GI motility –> beta-glucoronidase in meconium unconjugates bilirubin

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8
Q

Jaundice from hemolysis

A

hemolysis –> breakdown of RBCs –> hemoglobin –> unconjugated bilirubin –> binds albumin –> liver metabolized to conjugated bilirubin –> excreted in bile and into intestine –> lack of flora causes unconjugated to be reabsorbed

  • Rh incompatibility (mom neg)
  • ABO incompatibility (mom O)
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9
Q

Other causes of jaundice

A

non-hemolyic RBC breakdown - bruising during birth, polycythemia
Crigler-Nijar
Prematurity
Bowel Obstruction

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10
Q

Typical breastfeeding pattern

A

8-12 times in 24 hrs

roughly 10-15 mintues each side which declines as baby grows and gets more milk

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11
Q

Benefits of breastfeeding

A

Baby - bonding, immunity, reduced SIDS, less allergies

Mom - bonding, lower depression, weight loss, lower cost, improved bone mineralization

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12
Q

Breast milk nutrients

A

Carbs, fats, proteins

- breast milk is best because of other things included, microflora, immunity, etc

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13
Q

Breastfeeding problems

A

enlarged, tender breasts
improper latch
prolonged feedings
maternal inexperience/anxiety

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14
Q

Evaluation of infant jaundice

A 
Age of onset
Birth weight/history
Feeding history/schedule
Maternal history/prenatal history
Fever/infection?
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15
Q

G6PD deficiency

A

X-linked
- cannot fully complete PPP shunt and cannot reduced glutathione –> more susceptible to oxidative stress –> more hemolysis

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16
Q

Hereditary forms of hemolysis

A 
G6PD
Spherocytosis
Elliptocytosis
Thalassemia
Sickle Cell
Pyruvate kinase deficiency
17
Q

Biliary Atresia

A

healthy appearing infant who develops jaundice, dark urine, and pale stools 3-6 weeks after birth –> THINK BILIARY ATRESIA

18
Q

Voiding and stool patterns in infants

A

6-8 wet diapers a day

3-4 stools per day (should not be white stool)

19
Q

Prognosis of hyperbilirubinemia

A

Most are fine and self-resolve
Kernicterus is rare but can happen
MAJOR RISKS - preterm, blood incompatibility, jaundice observed in first 24 hrs

20
Q

Supplementing exclusive breast fed babies

A

Vitamin D is only recommended

400 U/day

21
Q

Birth weight and weight loss

A

Babies may lose up to 10% of birth weight and should regain this weight by 2 weeks

22
Q

PE of jaundice

A

Inspection - starts on face and progresses down body

  • when on body, bilirubin is approx 10-15 mg/dL
  • should get a serum level if you are truly concerned about hyperbilirubinemia
  • look for cephalohematoma or bruising –> can cause hyperbilirubinemia
23
Q

DDx for jaundice of newborn

A 
Breastmilk Jaundice
Physiologic Jaundice
Hemolysis
Hypothyroidism
Metabolic Disease
Gilbert Disease - harmless cause (GGT enzyme activity)
Biliary Atresia
Crigler-Najar
Trauma
Sepsis
24
Q

Hereditary forms present

A

If hereditary forms are present in families and an infant is jaundice –> you should ABSOLUTELY consider investigating these

25
Q

Hemolysis investigation

A

if there is Rh or ABO incompatibility –> need to investigate this possibility (CBC)

26
Q

Timing of neonatal screen

A

Ideally >24 hrs after birth

- may miss PKU if done before 24 hrs

27
Q

Congenital Hypothyroidism

A 
prolonged jaundice
lethargy
large fontanelles
macroglossia
umbilical hernia
constipation
developmental delay
28
Q

Phototherapy

A

wave length of 450 nm –> absorbed by bilirubin and makes it more water soluble and can be excreted without being conjugated

Pediatrics (36 decks)

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