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Y4R1 - Pediatrics I 👶 > L3: Neonatal Jaundice > Flashcards

L3: Neonatal Jaundice Flashcards

1
Q

Bilirubin Metabolism

A
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2
Q

Bilirubin Metabolism

  • RES
A

Most of bilirubin (75%) is derived from the breakdown of RBCs

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3
Q

Bilirubin Metabolism

  • Plasma
A

Unconjugated bilirubin tightly bound to albumin → become Water insoluble

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4
Q

Bilirubin Metabolism

  • Liver
A
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5
Q

Bilirubin Metabolism

  • Intestine
A
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6
Q

Why Jaundice is important in newborn babies?

A
  • It is a common problem that may indicate underlying disease
  • Unconjugated bilirubin is neurotoxic
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7
Q

Etiology of Neonatal Jaundice

A
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8
Q

Etiology of Neonatal Jaundice

  • Unconjugated Hyperbilirubenemia
A
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9
Q

Etiology of Neonatal Jaundice

  • Conjugated Hyperbilirubenemia
A
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10
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Increased hemolysis
A
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11
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Corpuscular Hemolysis
A
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12
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Extracorpuscular Hemolysis
A
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13
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Immunological Hemolysis
A
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14
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Infectious Hemolysis
A
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15
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Traumatic Hemolysis
A
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16
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Toxic Hemolysis
A

excessive Vit K administration’’

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17
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Polycythemia
A

…

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18
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Decreased Conjugation
A

Physiological jaundice

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19
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Immature glucuronyl transferase enzyme
A
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20
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Inhibited glucuronyl transferase enzyme
A
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21
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Absent or decreased glucuronyl transferase enzyme
A
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22
Q

Etiology of Neonatal Unconjugated Hyperbilirubinemia

  • Inadequate or poor feeding intake
A
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23
Q

Etiology of Neonatal Conjugated Hyperbilirubinemia

A
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24
Q

Etiology of Neonatal Conjugated Hyperbilirubinemia

  • Neonatal hepatitis
A
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25
Q

Etiology of Neonatal Conjugated Hyperbilirubinemia

  • Biliary Obstruction
A

…

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26
Q

Etiology of Neonatal Conjugated Hyperbilirubinemia

  • Increased entero-hepatic circulation
A
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27
Q

Incidence of Physiological Jaundice

A

The commonest cause of neonatal jaundice

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28
Q

Timing of Physiological Jaundice

A
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29
Q

Characters of Physiological Jaundice

A
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30
Q

Characters of Physiological Jaundice

  • Onset
A

▪ After 24 hours (on 2nd
▪ Never in 1st day

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31
Q

Characters of Physiological Jaundice

  • Peak
A

▪ By 4th-5th day in term.
▪ 7th day in preterm.

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32
Q

Characters of Physiological Jaundice

  • Dissappearence
A

▪ By 7-10 days of life.
▪ Clinically not detectable after 14 days.

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33
Q

Characters of Physiological Jaundice

  • Max Level
A

Doesn’t exceed 15 mg/dL

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34
Q

Characters of Physiological Jaundice

  • General Condition
A

Good & kernicterus doesn’t occur

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35
Q

Mechanism of Physiological Jaundice

A
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36
Q

Mechanism of Physiological Jaundice

  • Main Cause
A

Relative immaturity of glucuronyl transferase enzyme

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37
Q

Managment of Physiological Jaundice

A
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38
Q

Exaggerated Physiological Jaundice

A
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39
Q

Causes of Exaggerated Physiological Jaundice

A
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40
Q

Examples of Exaggerated Physiological Jaundice

A
  • Breastfeeding jaundice ‘’ Breast milk deficiency jaundice’’
  • Breast Milk Jaundice
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41
Q

Another Name of Breastfeeding jaundice

A

Breast milk deficiency jaundice

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42
Q

Incidence of Breastfeeding jaundice

A

13% of breast-fed infants

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43
Q

Etiology of Breastfeeding jaundice

A
  • ↓↓ milk intake with dehydration → ↑↑ enterohepatic circulation.
  • ↓↓ caloric intake by giving supplement of glucose water to breast fed jaundice
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44
Q

Characters of Breastfeeding jaundice

  • Onset
  • Peak
  • Disappearence
  • Bili Lvl
  • General Condition
A
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45
Q

Dx of Breastfeeding jaundice

A

…..

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46
Q

Prevention & TTT of Breastfeeding jaundice

A
  • Frequent breast-feeding day and night.
  • Discourage 5% dextrose or water supplementation
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47
Q

Incidence of Breast Milk Jaundice

A

2% of breast-fed term infants ‘’Recurrence in 70% of future pregnancy’’

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48
Q

Etiology of Breast Milk Jaundice

A
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49
Q

Characters of Breast Milk Jaundice

  • Onset
  • Peak
  • Disappear
  • Bili LVL
  • General Condition
A
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50
Q

Dx of Breast Milk Jaundice

A
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51
Q

Prevention & TTT of Breast Milk Jaundice

A
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52
Q

Compare between Physiological, Breast Feeding & Breast Milk in terms of:

  • Incidence
  • Characters
  • Onset
  • Peak
  • Disappearence
  • Bili LVL
  • TTT
A
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53
Q

Onset of Pathological Jaundice

A

Appearing in the 1st day or after the 1st week.

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54
Q

Duration of Pathological Jaundice

A

Persisting after 14 days

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55
Q

Bili LVL in Pathological Jaundice

A
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56
Q

General Condition in Pathological Jaundice

A

▪ Signs of underlying illness.

▪ Pallor, hepatomegaly & splenomegaly → signs of hemolytic anemia

57
Q

Stool & Urine in Pathological Jaundice

A

▪ Stool clay colored.
▪ Urine staining clothes yellow

58
Q

Familial Hx in Pathological Jaundice

A

Familial history of hemolytic disease

59
Q

Etiology of Pathological Jaundice

A
  • Unconjugated hyper-bilirubine
  • Conjugated hyper-bilirubinemia
60
Q

Etiology of Pathological Jaundice

  • Unconjugated Hyperbilirubinemia
61
Q

Etiology of Pathological Jaundice

  • Conjugated Hyperbilirubinemia
62
Q

Etiology of Pathological Jaundice

  • Conjugated Hyperbilirubinemia (Hepatocellular failure of transport or excretion (Neonatal hepatitis)
63
Q

Etiology of Pathological Jaundice

  • Conjugated Hyperbilirubinemia (Biliary obstruction)
64
Q

Etiology of Pathological Jaundice

  • Conjugated Hyperbilirubinemia (Increased enterohepatic circulation)
65
Q

Rh Incompatibility & ABO Incompatability

  • Incidence
66
Q

Rh Incompatibility & ABO Incompatability

  • Etiology
67
Q

CP of Rh Incompatibility & ABO Incompatability

  • First Baby
  • Severity
  • jaundice
  • Pallor
  • Liver & Spleen
  • Hydrops Fetalis
68
Q

Dx of Rh Incompatibility & ABO Incompatability

  • Blood Group
  • Hemolytic anemia
  • Coomb’s test
  • HB
  • Others?
69
Q

Prevention of Rh Incompatibility & ABO Incompatability

70
Q

TTT of Rh Incompatibility & ABO Incompatability

71
Q

Prenatal TTT of Rh Incompatibility

72
Q

Prenatal TTT of Rh Incompatibility

  • Serial anti D titer determination
A
  • for evaluation of sensitization in Rh negative pregnant woman.
73
Q

Prenatal TTT of Rh Incompatibility

  • Evaluation of fetal well-being (if mother is
    sensitized) by ….
A
  • Repeated fetal ultrasound for hydrops fetalis
  • Amniocentesis & cordocentesis.
74
Q

Prenatal TTT of Rh Incompatibility

  • Interference (if the titer is critically rising) either
    by ……
A
  • Premature induction of labor.
  • Intrauterine exchange transfusion (with O -ve RBCs into fetal umbilical vein)
75
Q

Postnatal TTT of Rh Incompatability

76
Q

Postnatal TTT of Rh Incompatability

  • Exchange Transfusion
77
Q

Postnatal TTT of Rh Incompatability

  • Indications of Exchange Transfusion
78
Q

Postnatal TTT of Rh Incompatability

  • Phototherapy
A

Before and after exchange transfusion to prevent
further increase of Bilirubin

79
Q

Postnatal TTT of Rh Incompatability

  • IVIG
80
Q

Pre-natal TTT of ABO Incompatability

A

No preventive measures except for instructions
especially to group O pregnant women.

81
Q

Post natal TTT of ABO Incompatability

82
Q

Early detection is crucial for early start of phototherapy since some cases may have high bilirubin level eventually → kernicterus

83
Q

Compare between Rh Incompatability & ABO Compatability

84
Q

Types of Crigler-Najjar syndrome

A
  • Crigler-Najjar syndrome type I
  • Crigler-Najjar syndrome type II
85
Q

Compare between CN I & CN II in terms of:

  • Inheritance
  • UGT activity
  • jaundice
  • TTT
86
Q

Incidence of Gilbert’s syndrome

A

Most common inherited disorder of bilirubin glucuronidatio

87
Q

Etiology of Gilbert’s syndrome

A
  • Mutation in the promoter region of the UGT1A1 gene → ↓↓ production of UGT
88
Q

Dx of Unconjugated Hyperbilirubinemia

89
Q

Dx of Unconjugated Hyperbilirubinemia

  • Hx
90
Q

Dx of Unconjugated Hyperbilirubinemia

  • Ex
91
Q

Dx of Unconjugated Hyperbilirubinemia

  • INVx
92
Q

Def of Bilirubin Encephalopathy (Kernicterus)

93
Q

pathophysioology of Bilirubin Encephalopathy (Kernicterus)

94
Q

Bilirubin Encephalopathy (Kernicterus)

  • Factors determining brain damage
95
Q

CP of Bilirubin Encephalopathy (Kernicterus)

96
Q

CP of Bilirubin Encephalopathy (Kernicterus)

  • Acute
97
Q

CP of Bilirubin Encephalopathy (Kernicterus)

  • Acute (1st Phase)
98
Q

CP of Bilirubin Encephalopathy (Kernicterus)

  • Acute (2nd Phase)
99
Q

CP of Bilirubin Encephalopathy (Kernicterus)

  • Acute (3rd Phase)
100
Q

CP of Bilirubin Encephalopathy (Kernicterus)

  • Chronic
101
Q

TTT of Uncojugated Hyperbilirubinemia

102
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Def
A

Exposure of the skin to day light lamps with wavelength 425-475 nanometer.

103
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Mechanism
104
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Factors influencing efficiency of phototherapy
105
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Types
106
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Application of phototherapy ‘’precautions’’
107
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Indications
108
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Technique
A

Repeat S. bilirubin measurement
- 4–6 hours after initiating phototherapy.
- Then every 6–12 hours when the serum bilirubin level is stable or falling.

109
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • when to stop?
A

When S. bilirubin is 3 m g/ dl below the phototherapy threshold

‘‘12 – 13 m g/ dl’’

110
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • Follow up
A

Repeat serum bilirubin measurement 12–18 hours after stopping phototherapy for rebound of significant hyperbilirubinemia.

111
Q

Phototherapy in TTT of Uncojugated Hyperbilirubinemia

  • SE
112
Q

Rule of Home phototherapy

A
  1. Alternative to readmission to the hospital
  2. Less disruptive to the family
113
Q

Indications of Home phototherapy

114
Q

Value of Sunlight exposure

A

Exposure to sunlight provides sufficient irradiance in the 425 to 475 nm band.

115
Q

Rule of Sunlight exposure

A

Not recommended —> to avoid sunburn

116
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Indications
117
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Aim
A
  • Remove indirect bilirubin.
  • Remove sensitized cells.
  • Correct anemia.
118
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Amount
A

Double blood volume (2 X 85 X body weight in kg)

119
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Type of Blood
120
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Technique
A

Umbilical vein catheter Alternating pull & push of 10-20 ml blood.

121
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • Complications
122
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • To decrease the risk of GVHD, ……
A

use Irradiated blood products

123
Q

Exchange Transfusion in TTT of Hyperbiliruinemia

  • After exchange transfusion, …..
A
  • Maintain continuous multiple phototherapies.
  • Measure serum bilirubin level within 2 hours and manage accordingly.
124
Q

Indications of IVIG

A

When bilirubin level surpasses the exchange transfusion limit.

125
Q

Aim of IVIG

A
  • To ↓↓ the level of bilirubin in infants with isoimmune hemolytic disease.
126
Q

Mechanism of IVIG

127
Q

Dosage of IVIG

128
Q

Def of Conjugated Hyperbilirubinemia

A

↑↑ level of direct or conjugated bilirubin > 20 % of total serum bilirubin.

129
Q

Etiology of Conjugated Hyperbilirubinemia

A

Mentioned before (See causes of pathological jaundice)

130
Q

Dx in Conjugated Hyperbilirubinemia

  • Hx
131
Q

Dx of Conjugated Hyperbilirubinemia

  • Ex
132
Q

Dx of Conjugated Hyperbilirubinemia

  • INVx
133
Q

DDx of Jaundice

134
Q

DDx of Jaundice

  • 1st 24 hours
135
Q

DDx of Jaundice

  • 24 hours - 72 hours
136
Q

DDx of Jaundice

  • 3rd - 5th day
137
Q

DDx of Jaundice

  • After 1st week
138
Q

DDx of Jaundice

  • More than 4 weeks

Y4R1 - Pediatrics I 👶 (49 decks)

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