Jaundice Flashcards
Indirect (unconjugated) hyperbilirubinemia
Physiological jaundice
Presents first 36-48 hours of life, reaches peak total bilirubin levels 10-15 at 5-7 days of life
Physiological jaundice
If severe or prolonged, occurs within first 24 hours of life, or associated with increased directed (conjugated) component
Less likely to be physiological
Initial evaluation should include both ________ to establish whether high bilirubin levels are direct or indirect
Total and direct bilirubin
Increase feedings, UV phototherapy, exchange transfusion for severe jaundice. Trend serum bilirubin levels
Treatment for physiological jaundice
Has an enzyme that delays hepatic bilirubin conjugation and prolongs jaundice in newborns
Breast milk
Presents after first 3-5 days of life and peaks at 2 weeks. Total bilirubin levels reach 19-20 and may persist for 1-2 months
Breast milk jaundice
Rarely requires phototherapy. Encourage breast feeding because jaundice will usually go away on its own
Breast milk jaundice
Direct bilirubin of > ________ OR __________ of total bilirubin indicates a hepatobiliary or general metabolic disorder
10%
2 mg/dL
Very high levels of unconjugated bilirubin (> _______ ) can cross the blood-brain barrier and deposit in the basal ganglia causing kernicterus (irreversible, potentially fatal encephalopathy)
30 mg/dL
Indirect
Unconjugated bilirubin
Direct
Conjugated bilirubin
Jaundice, lethargy, poor feeding, high-pitched cry, hypertonicity, and seizures
Kernicterus
Order CBC (to assess for anemia), reticulocyte count, and peripheral smear (assess for hemolysis)
Hyperbilirubinemia
________ test can distinguish antibody mediated disease (ABO incompatibility) from non-immune mediated (G6PD deficiency, hereditary spherocytosis)
Coombs