Jaundice Flashcards
Interviewing new parents
- offer congrats, comment on growth
- ask their concerns
- be aware of baby blues and postpartum depression
Jaundice
- hyperbilirubinemia –> conjugated and unconjugated
- unconjugated causes problems
Newborn bilirubin physiology
~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
Kernicterus
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
Etiologies of Jaundice
Physiologic Jaundice
Breastfeeding
Hemolysis
Other
Physiologic Jaundice
Total bilirubin
Jaundice with breastfeeding
Occurs early when supply is low –> low GI motility –> beta-glucoronidase in meconium unconjugates bilirubin
Jaundice from hemolysis
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)
Other causes of jaundice
non-hemolyic RBC breakdown - bruising during birth, polycythemia
Crigler-Nijar
Prematurity
Bowel Obstruction
Typical breastfeeding pattern
8-12 times in 24 hrs
roughly 10-15 mintues each side which declines as baby grows and gets more milk
Benefits of breastfeeding
Baby - bonding, immunity, reduced SIDS, less allergies
Mom - bonding, lower depression, weight loss, lower cost, improved bone mineralization
Breast milk nutrients
Carbs, fats, proteins
- breast milk is best because of other things included, microflora, immunity, etc
Breastfeeding problems
enlarged, tender breasts
improper latch
prolonged feedings
maternal inexperience/anxiety
Evaluation of infant jaundice
Age of onset Birth weight/history Feeding history/schedule Maternal history/prenatal history Fever/infection?
G6PD deficiency
X-linked
- cannot fully complete PPP shunt and cannot reduced glutathione –> more susceptible to oxidative stress –> more hemolysis
Hereditary forms of hemolysis
G6PD Spherocytosis Elliptocytosis Thalassemia Sickle Cell Pyruvate kinase deficiency
Biliary Atresia
healthy appearing infant who develops jaundice, dark urine, and pale stools 3-6 weeks after birth –> THINK BILIARY ATRESIA
Voiding and stool patterns in infants
6-8 wet diapers a day
3-4 stools per day (should not be white stool)
Prognosis of hyperbilirubinemia
Most are fine and self-resolve
Kernicterus is rare but can happen
MAJOR RISKS - preterm, blood incompatibility, jaundice observed in first 24 hrs
Supplementing exclusive breast fed babies
Vitamin D is only recommended
400 U/day
Birth weight and weight loss
Babies may lose up to 10% of birth weight and should regain this weight by 2 weeks
PE of jaundice
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
DDx for jaundice of newborn
Breastmilk Jaundice Physiologic Jaundice Hemolysis Hypothyroidism Metabolic Disease Gilbert Disease - harmless cause (GGT enzyme activity) Biliary Atresia Crigler-Najar Trauma Sepsis
Hereditary forms present
If hereditary forms are present in families and an infant is jaundice –> you should ABSOLUTELY consider investigating these
Hemolysis investigation
if there is Rh or ABO incompatibility –> need to investigate this possibility (CBC)
Timing of neonatal screen
Ideally >24 hrs after birth
- may miss PKU if done before 24 hrs
Congenital Hypothyroidism
prolonged jaundice lethargy large fontanelles macroglossia umbilical hernia constipation developmental delay
Phototherapy
wave length of 450 nm –> absorbed by bilirubin and makes it more water soluble and can be excreted without being conjugated
