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11 Neonatology > Jaundice > Flashcards

Jaundice Flashcards

1
Q

elevated levels of bilirubin in the serum

A

hyperbilirubinemia

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2
Q

yellowish discoloration of the skin and mucous membranes

A

jaundice

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3
Q

enzyme that liberates chelated iron from heme structure

A

heme oxygenase

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4
Q

indirect vs direct bilirubin

A

indirect = bilirubin-albumin complex (water insoluble)

direct bilirubin = conjugated bilirubin (water soluble)

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5
Q

enzyme the conjugates bilirubin with glucoronic acid

A

udp glucuronyl transferase

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6
Q

most common morbidity in the newborn period

A

bilirubin levels >12.8 mg/dl (physiologic jaundice)

jaundice = >5 mg/dl

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7
Q

neonatal vs adult metabolism values

A

production 6-8 mg/kg/d vs 3-4
rbc volume 16-18 mg% vs 12-14 mg%
rbc lifespan 90 d vs 120 d

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8
Q

neonatal vs adult bilirubin metabolism

A

lower concentration of albumin
lower concentration of enzyme transferase
large bilirubin pool in the meconium (1 g meconium = 1 mg bilirubin)

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9
Q

meconium starts to be excreted by ___

A

10-16 wks aog

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10
Q

characteristics of unconjugated (indirect) bilirubin

A

lipid soluble = neurotoxic
poorly soluble in water, non-polar
passes the bbb readily
albumin bound in plasma

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11
Q

characteristics of conjugated (direct) bilirubin

A

water-soluble
actively transported to biliary tree

neonatal cholestasis/cholestatic jaundice = >20% of total bilirubin is conjugated (>2 wks)

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12
Q

bilirubin levels in physiologic jaundice

A

3rd day: 7-7.5 mg%
3rd-5th day: peak
5-th-7th day: < 2 mg/dl

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13
Q

onset and factors for breastfeeding jaundice

A

onset: 3-4 days of life
factors: inadequate nursing, decreased stool output, increased enterohepatic circulation

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14
Q

jaundice where the onset is at the end of the first week of life

A

breastmilk jaundice

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15
Q

what to do if baby is still jaundiced at 1-2 mos

A
  • check if direct hyperbilirubinemia
  • if direct >20% total or >2 mg/dl = neonatal cholestasis
  • if direct is less + no hemolysis = breastmilk jaundice
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16
Q

causes of pathologic jaundice

A

overproduction of bilirubin
undersecretion of bilirubin
mixed

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17
Q

levels of hyperbilirubinemia

A

significant: >95th percentile, >17 mg/dl at 72 hrs
severe: 99th percentile, >20 mg/dl
extreme: >99.5th percentile, >25 mg/dl

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18
Q

causes of overproduction of bilirubin

A

increased rbc breakdown due to

  • hemolytic disorders (rh/abo, genetic, drugs)
  • extravasated blood
  • polycythemia
  • exaggerated enterohepatic circulation (reduced peristalsis, mechanical obstruction)
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19
Q

causes of undersecretion of bilirubin

A

decreased hepatic uptake
decreased bilirubin conjugation
impaired transport of conjugated bilirubin out of hepatocyte
obstruction to bile flow

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20
Q

mixed causes of pathologic jaundice

A

intrauterine infection (torch, syphilis, hepa/b)
postnatal infections
multi-system disorders

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21
Q

complications of hyperbilirubinemia in newborns

A
  • bilirubin toxicity
  • kernicterus
  • active bilirubin encephalopathy (abe)
  • bilirubin-induced neurologic dysfunction (bind)
  • chronic bilirubin encephalopathy (cbe)
  • subtle bilirubin encephalopathy
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22
Q

important cause of cerebral palsy, developmental delay, or hearing impairment and the most preventable cause of cerebral palsy

A

bilirubin toxicity

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23
Q

pathologic findings of bilirubin toxicity in the brain (staining/necrosis)

A

kernicterus

bilirubin induces lipid peroxidation -> neuroinflammation and mitochondrial failure (loss of atps) -> apoptosis and neuronal death

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24
Q

phases of acute bilirubin encephalopathy

A

first days and weeks following hyperbilirubinemic event

1: poor sucking, lethargy, stupor, hypotonia, seizure
2: middle of the week, alternating hyper/hypotonia, opisthotonus, fever, upward gaze paralysis
3: after 1 week, hypertonia

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25
Q

abe tests and imaging results

A 
abnormal baer (brainstem auditory evoked response)
lesions in globus pallidum on mri
26
Q

the subtle form of brain injury due to the effects of bilirubin toxicity but comprising less obvious neurologic manifestations

A

bilirubin induced neurologic dysfunction

27
Q

bind scoring system

A

mental status
muscle tone
cry

=6 reversible
7-9 irreversible

28
Q

clinical triad of post icteric sequelae in chronic bilirubin encephalopathy (permanent)

A

4E: EXTRAPYRAMIDAL, EYES, EARS, EEE (smile)

extrapyramidal abnormalities (athetoid cp and spasticity)
deafness or diminished hearing
impaired upward gaze
dental enamel dysplasia

29
Q

t/f for those who have abe, 50% will die and those who will survive will have bind

A

false, cbe

30
Q

most preventable cause of cerebral palsy

A

chronic bilirubin encephalopathy

31
Q

manifestation of subtle bilirubin encephalopathy in school aged children/adults

A

subtle bilirubin encephalopathy

32
Q

clinical manifestations of subtle bilirubin encephalopathy

A

isolated hearing loss
gaze abnormality
gait abnormality

33
Q

why is bilirubin produced?

A
  • iron salvage pathway: carbon monoxide, iron, biliverdin
  • potent scavenger of peroxyl radicals
  • inhibit the effects of mutagens
  • anti-oxidants
34
Q

basic principles of preventing severe hyperbilirubinemia

A
  • recognize risk factors
  • vigilant in-hospital monitoring
  • post-discharge monitoring
  • adequate breastfeeding support
  • parenteral and nursing education
35
Q

what to check to prevent sever hyperbilirubinemia

A
  • risk factors
  • jaundice
  • follow up 48-72 hrs if discharged <72 hrs
  • einc and lactation counselors
  • written and oral information in the nicu
36
Q

clinical assessment of jaundice after birth

A

visual assessment: monitor as a vital sign at 8h
bilirubin testing in nbs
check risk factors (late preterm, bruising, race)

37
Q

t/f if the baby is jaundiced, you can’t reliably estimate the bilirubin levels

A

true

38
Q

transcutaneous bilirubin can be tested on __

A

> 35 weeks

postnatal age >24 hrs

39
Q

indications for serum bilirubin test

A

tcb reading > 250 mg/dl
jaundice in first 24 hrs
<35 wks aog

40
Q

t/f forehead tcb has better correlation efficient

A

false, chest has better due to less exposure to sunlight

41
Q

risk factors for the development of severe bilirubinemia in infants >35 weeks

A 
age 35-36 wks
exclusive breastfeeding
abo incompatibility
g6pd deficiency
east asian race
42
Q

risk stratification depends on ___ approach

A

hour of life approach

43
Q

t/f late preterm babies act like term babies

A

false, they can act like preterm despite having the size of a term baby

have an 8 fold increase in developing tsb of >20 mg/dl

44
Q

t/f hyperbilirubinemia in east asians are more prevalent, more pronounced, and more protracted

A

true

45
Q

indications for phototherapy

A

24 hol > 12
48 hol >15
72 hol > 18

46
Q

indications for exchange transfusion

A

24 hol > 19
48 hol > 22
72 hol > 24
>72 hol >/= 25

47
Q

process where water insoluble bilirubin is converted into water soluble forms without conjugation in the liver

A

phototherapy

48
Q

what is photooxidationi

A

bleaching reaction where oxidation of bilirubin into polar and water soluble products is done

49
Q

what is photoisomerization

A

configurational (fast/major)

structural: form lumirubin, irreversible (slow)

50
Q

ideal wavelength of phototherapy

A

450 nm (blue)

51
Q

t/f circumferential therapy has more exposure, but conventional has less treatment failures

A

true

52
Q

a cheaper phototherapy alternative for low resource areas

A

led phototherapy

53
Q

t/f turning is necessary when doing phototherapy

A

false, there’s no difference

54
Q

t/f there is a difference between continuous and intermittent phototherapy

A

false, no difference

55
Q

if bilirubin is ___, they can carry their child to the wards and still do intermittent phototherapy

A

<20 mg/dl

56
Q

t/f sunlight exposure can be done to the baby

A

false, aap recommends against it. sunlight exposure 6-9 am daily in first week of life is ok

avoid 10 am - 2 pm sun exposure

57
Q

exchange transfusion can decrease bilirubin by ___

A

50%

exchanging blood of the infant with type o or o-

58
Q

t/f phototherapy can be shortened and less exchange transfusions can be done if ivig is done with phototherapy

A

true

59
Q

a lipid reducing substance that can reduce total bilirubin

A

clofibrate

60
Q

drug that can induce glucuronyl transferase as ancillary therapy

A

phenobarbital

  • take 5-7 days to effect
  • prophylactic and not sued in severe levels
61
Q

inhibits heme oxygenase

A

tin-mesoporphyrin

11 Neonatology (9 decks)

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