Jaundice

Question 1

Why is physiologic jaundice so common?

Answer 1

fetus needs high levels of Hb to attract O2 across placenta…after birth extra gets broken down

Question 2

Neonatal RBC lifespan

Answer 2

60-70 days

Question 3

timing of physiologic jaundice

Answer 3

NEVER before 24 hours
highest level 3-4 days
faed by 7 days, resolved by 14 days

Question 4

NON physiologic jaundice causes

Answer 4

hemolytic disorders (Rh, ABO incompatibility, G6DH def, spherocytosis)
Infections (sepsis, UTI)
extravasation (cephalohematoma, birth trauma, cavernous hemangioma)
polycythemia (twin to twin, delayed cord clamp, SGA babies)
deconguation in gut (breast milk jaundice)
defects of conjugation (preterm, infxn)
obstruction (biliary atresia, hepatitis)

Question 5

Drugs that can cause jaundice

Answer 5

salicylates
steroids
sulphonamides
diazepam

Question 6

Jaundice Treatment: bowel transit time

Answer 6

DECREASE IT
increase freq of feedings
rectal stimulation

Question 7

Jaundice Treatment: phototherapy

Answer 7

natural light- keep baby warm

artificial light- blue, cover baby’s eyes

Question 8

Jaundice Tx: transfusion

Answer 8

severely anemic, does not respond to photo, bilirubin extremely high, high direct bilirubin

Question 9

Jaundice Treatment: naturopathic

Answer 9

increase bowel TT, photo, activated charcoal

Question 10

RISK FACTORS

Answer 10

Race- E Asian, Native Am, Greek
sibling with jaundice
maternal risks- older, primip, DM, HTN, OCP use, 1st trimester bleeding, Zinc def
high altitude

Question 11

Risk Factors: Drugs

Answer 11

oxytocin, epidural, diazepam

Question 12

Risk Factors: L&D

Answer 12

PROM, forceps, vacuum, breech

Question 13

Risk Factors: Infant

Answer 13

low birth weight, preterm, M, delayed cord clamp, elevated cord bilirubin, delayed meconium, caloric deprivation, large weight loss after birth, low zinc/Mg

Question 14

Chelidonium

Answer 14

THE jaundice remedy

red pimples/pustules, colic, better eating, > Pressure,

Question 15

Aconite

Answer 15

jaundice d/t shock, fright
one cheek pale, one hot red
dry, swollen mouth
WORSE NIGHT

Question 16

Arnica

Answer 16

bruising, traumatic birth

Question 17

Bovsita

Answer 17

yellow skin with eczema, lassitude

Question 18

Elaterium

Answer 18

infant yawns and stretches violently

frothy violent vomit

Question 19

Mercury

Answer 19

puffy face, hepatomegaly
Hx of STD in MOB
hiccoughs

Question 20

Nat sulph

Answer 20

head trauma, brick dust urine

Question 21

Nux vomica

Answer 21

esp if MOB given drugs

hot, red, blotchy skin

Question 22

Sulphur

Answer 22

baby emaciated, lips dry and bright red

jerks and twitched in sleep, wakes suddenly

Question 23

Danger Signs in jaundiced infant

Answer 23

Onset of jaundice in first 24 hours
Late onset after 4 days
Vomiting
Lethargy
Poor feeding
Fever
High pitched cry
Dark urine
Light stools

Question 24

Complications of Jaundice: Kernicterus

Answer 24

Staining and toxicity of CNS; hypotonia, high pitched cry

Question 25

Complications of Jaundice: Chronic Encephalopathy

Answer 25

Extrapyramidal disturbances -Athetosis, rigidity, drooling, grimacing, difficulty chewing and swallowing, dysarthria
Auditory abnormalities - Hearing loss
Gaze abnormalities - limited upward gaze
Dental dysplasia -
Severe hemolytic disease
a.	Liver/Spleen enlargement
b.	anemia
c.	pallor
d.	edema ! ascites (if Rh HDN)