Jaundice Flashcards
Why is physiologic jaundice so common?
fetus needs high levels of Hb to attract O2 across placenta…after birth extra gets broken down
Neonatal RBC lifespan
60-70 days
timing of physiologic jaundice
NEVER before 24 hours
highest level 3-4 days
faed by 7 days, resolved by 14 days
NON physiologic jaundice causes
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)
Drugs that can cause jaundice
salicylates
steroids
sulphonamides
diazepam
Jaundice Treatment: bowel transit time
DECREASE IT
increase freq of feedings
rectal stimulation
Jaundice Treatment: phototherapy
natural light- keep baby warm
artificial light- blue, cover baby’s eyes
Jaundice Tx: transfusion
severely anemic, does not respond to photo, bilirubin extremely high, high direct bilirubin
Jaundice Treatment: naturopathic
increase bowel TT, photo, activated charcoal
RISK FACTORS
Race- E Asian, Native Am, Greek
sibling with jaundice
maternal risks- older, primip, DM, HTN, OCP use, 1st trimester bleeding, Zinc def
high altitude
Risk Factors: Drugs
oxytocin, epidural, diazepam
Risk Factors: L&D
PROM, forceps, vacuum, breech
Risk Factors: Infant
low birth weight, preterm, M, delayed cord clamp, elevated cord bilirubin, delayed meconium, caloric deprivation, large weight loss after birth, low zinc/Mg
Chelidonium
THE jaundice remedy
red pimples/pustules, colic, better eating, > Pressure,
Aconite
jaundice d/t shock, fright
one cheek pale, one hot red
dry, swollen mouth
WORSE NIGHT
Arnica
bruising, traumatic birth
Bovsita
yellow skin with eczema, lassitude
Elaterium
infant yawns and stretches violently
frothy violent vomit
Mercury
puffy face, hepatomegaly
Hx of STD in MOB
hiccoughs
Nat sulph
head trauma, brick dust urine
Nux vomica
esp if MOB given drugs
hot, red, blotchy skin
Sulphur
baby emaciated, lips dry and bright red
jerks and twitched in sleep, wakes suddenly
Danger Signs in jaundiced infant
Onset of jaundice in first 24 hours Late onset after 4 days Vomiting Lethargy Poor feeding Fever High pitched cry Dark urine Light stools
Complications of Jaundice: Kernicterus
Staining and toxicity of CNS; hypotonia, high pitched cry
Complications of Jaundice: Chronic Encephalopathy
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)
