Jaundice/Hyberbilirubnemia

Question 1

What is bilirubin?

Answer 1

end product of heme metabolim
at high level= it’s toxic
at low levels =it’s an antioxidant
tends to deposit in the skin and mucous membranes

Question 2

What is conjugated bilirubin? ( direct bilirubin)

Answer 2

more easily eliminated
water soluble
bound with glucuronic acid from body

Question 3

what is unconjugated bilirubin? (indirect bilirubin)

Answer 3

not bound
not water soluble
difficult to excrete

Question 4

Bilirubin metabolism how does it work?

Answer 4

lysis of RBC~ heme is catalyzed by heme oxygenate~ biliverdin converted into bilirubin~ unbound bilirubin transported to liver and bound to protein that makes it water soluble~ excreted into bile~ eliminated by stool

***if bilirubin is unbound it’s reabsorbed into circulation causing jaundice

Question 5

Peak level of bilirubin? when does it occur?

Answer 5

around 6 mg/dl

occurs around day 2-4 days of life

Question 6

Jaundice is ____ and doesn’t require_____

Answer 6

self limiting

intervention

Question 7

what causes hyperbilirubinemia in newborn?

Answer 7

hepatic immaturity
decreased ability to conjugate bilirubin
decrease rate of excretion
mild dehydration/ low caloric intake

Question 8

current guidelines for management of hyperbilirubnemia

Answer 8

• promote and support breastfeeding
• establish nursery protocols for identification and evaluation of hyberbilirubemia
• “bilicheck” ( transcutaneous) can only be useful on full term babies over 37 weeks
• measure TSB ( total serum bilirubin) or TcB (transcutaneous bilirubin) levels on infant who are jaundiced in the first 24 hrs of life
• very concerning if jaundice in first 24 hrs of life
• recognize that visual estimation of the degree of jaundice can lead to errors especially in darker pigmented babies

Question 9

Interpret all bilirubin levels according to the infants age in ______

Answer 9

hours

nomogram

Question 10

major risk factors for hyperbilirubnemia

Answer 10

Jaundice within the first 24 hrs~requires close follow up
A sibling who was jaundice
Unrecognized hemolysis
Non optimal sucking/nursing
Deficiency in G6PD
Infection
Cephalohematoma
Eastern Asian or mediterranean descent

Question 11

What is the definition of Pathologic jaundice?

Answer 11

timing and rate of rise~ when it occurs in the first 24 hrs of life, when it occurs after the first week of life and when it lasts longer than 2 weeks
Also if TSB rise of 5mg/dl or greater per day of life or a TSB greater than 18mg/dl

Question 12

Primary care management of hyperbilirubnemia

Answer 12

• for newborn discharged before 48 hrs of life~ first visit 1-3 days after discharge and second 3-5 days after discharge
• monitor infants’ weight, percent of change, intake, voiding/stooling, presence / absence of jaundice
• if there is doubt regarding the degree of jaundice, obtain a TSB or TcB
• biliblankets, home phototherapy, sunlight

Question 13

Causes of pathologic jaundice?

Answer 13

isoimmunization
erythrocyte biochemical defects
structural abnormalities
infection
sequestered blood

Question 14

What is the definition of physiologic jaundice?

Answer 14

gradual rise of bilirubin that occurs between 48 - 120 HRS ( 2 -5 days) of age