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Neonatal Intensive Care > Lecture 3 Part 1 > Flashcards

Lecture 3 Part 1 Flashcards

1
Q

What is jaundice a symptom of?

A

High bilirubin levels in the blood

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2
Q

What causes jaundice?

A

Accumulation of bilirubin in the skin and sclera, resulting in yellow discolouration

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3
Q

What happens when there is too much bilirubin?

A

Orange-yellow pigment formed by the breakdown of haemoglobin

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4
Q

Why is bilirubin needed?

A

It’s a normal catabolic pathway which is necessary for the clearance of waste products

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5
Q

What percentage of term babies get hyperbilirubinaemia?

A

60%

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6
Q

What percentage of preterm babies get hyperbilirubinaemia?

A

80%

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7
Q

Explain the process of bilirubin creation

A

Reticuloendothelial cells maintain the red blood cells levels by destroying abnormal and old red blood cells by breaking it down into haem and globin groups.

Globin is further broken down into amino acids and recycled

Haem is further broken down into iron and biliverdin. The iron is recycled and the biliverdin is reduced to create unconjugated bilirubin

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8
Q

Name the types of bilirubin and what they are also known as

A

Unconjugated - indirect

Conjugated - direct

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9
Q

Explain the process where conjugated bilirubin is formed from unconjugated bilirubin

A

In the bloodstream, unconjugated bilirubin bins to albumin and is transported to the liver

In the liver, the enzyme GLUCURONYL TRANSFERASE adds GLUCURONIC ACID to unconjugated bilirubin and it’s converted to conjugated bilirubin

Conjugated bilirubin is water soluble and can be excreted into the duodenum in bile

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10
Q

What is urobilinogen? What does it do?

A

A colourless byproduct of the breakdown of bilirubin in the intestines. Formed by gut bacteria on conjugated bilirubin.

Is it either reabsorbed into the bloodstream and excreted in urine as urobilin, giving urine its yellow colour, or it remains in the intestines and is converted to stercobilin, which gives stool its brown colour.

Monitoring urobilingoen levels in the urine can be helpful in diagnosing liver and blood disorders

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11
Q

What percentage of urobilinogen is reabsorbed back into the bloodstream as part of the enterohepatic circulation?

A

20%

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12
Q

Normal physiological jaundice occurs in all babies, when does it start to develop and how long does it last for?

A

Day 2 and lasts for around 2 weeks

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13
Q

What is needed for normal jaundice not to have an impact on the baby?

A

A well established feeding

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14
Q

If untreated, what can bilirubin do to the physiology?

A

Can cross the blood brain barrier

Damages the brain, spinal cord and central nervous system

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15
Q

If untreated, what conditions can high levels of bilirubin cause?

A

Encephalopathy
Hearing loss
Seizures
Muscle spasms
Cerebral palsy - dystonic CP
learning disabilities

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16
Q

What would be termed as pathological jaundice?

A

Any jaundice which presents under 24 hours of age, until proven otherwise and must be investigated promptly

Must be determined by a serum bilirubin

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17
Q

What are the common causes of early jaundice?

A

Haemolysis - due to blood group incompatibilities or spherocytosis/elliptocyosis
Infection, TORCH or baterial infections
Normal variant, diagnosis of exclusion

History
Mums bloody group, antenatal history, family history - siblings with jaundice

18
Q

What would be classed as prolonged jaundice?

A

Persists:
After 2 weeks of life in a term baby
After 3 weeks of life in a preterm baby

19
Q

What is the biggest differential in elevated bilirubin?

A

Whether the bilirubin is unconjugated or whether the conjugated fraction is substantially increased , more than 25% of the total

20
Q

What are the causes of persistent unconjugated hyperbilirubinaemia?

A

Poor milk intake
Haemolysis
Infections- especially urinary tract infection
Hypothyroidism
Breast milk jaundice (diagnosis of exclusion, cessation of breast feeding is not advised

21
Q

What disease is persistent jaundice in unconjugated hyperbilirubinaemia the earliest sign for?

A

Hypothyroidism, babies are screened for this disease

22
Q

What jaundice is present in otherwise healthy babies? And why?

A

Breast milk jaundice
They have normal conjugated portions, normal full blood count and blood group, no sign of infection and Haemolysis
Reassurance and no further action needed

23
Q

What type of high levels of bilirubin is always abnormal?

A

Conjugated

24
Q

What diseases conjugated hyperbilirubinaemia be a sign of?

A

Hepatitis - can be caused be infection or by metabolic disorders
Biliary atresia

25
Q

What condition leads to elevated conjugated bilirubin as a result of bile duct obstruction? Elaborate

A

Biliary atresia -
Fatal if not treated
Infants usually have pale (clay coloured) stools and dark urine
A surgical procedure called Kasai portoentrostomy is needed to treat, a diagnosis is needed 3 months prior of age
Success of the surgery is directly related to age of operation, less than 10 weeks because there is a better chance of bile flow and reduced need for liver transplant

26
Q

After how many days of life is neonatal jaundice common?

A

14

27
Q

How rare is biliary atresia?

A

Occurs in 1 in 14 000 to 1 in 21000 births so very rare

28
Q

What campaign has the UK got for being alert for what condition of elevated conjugated bilirubin?

A

Yellow Alert Campaign for biliary atresia

29
Q

What is the treatment used for jaundice? How does it work?

A

Phototherapy is the use of light to lower the serum bilirubin levels

It transforms bilirubin into water soluble without conjugation in the liver

Light waves absorbed by the skin and the blood and unconjugated bilirubin molecules are converted into water soluble isomers, which are forms of bilirubin that can be easily excreted in the urine without the liver having to process them

30
Q

What light is the most effective for phototherapy?

A

Blue green light with a range of 460-490nm

31
Q

What is the phototherapy effectiveness dependent on?

A

Wavelength of the light
Intensity of the light
The distance between the light and the infant
The amount of body area exposed to the light

32
Q

What phototherapy treatment for jaundice can be used? State the benefits and limitations

A

Fluorescent tubes
Halogen spotlights
These produce considerable heat which can be placed close to the infant

Fibre optic blankets - limited exposure area
LEDs - low heat production
Gallium nitric LEDs - produce a high intensity wavelength light

33
Q

If phototherapy is used over a neonate, what is the safety checklist for it?

A

Overheat unit with main power cable attached

Measuring device for radiating LED light

Appropriate sized eye protection mask

Cot

Towels for boundaries

34
Q

List the pros and cons for the having phototherapy over the neonate

A

Pros:
Height adjustable - can fit over any cot
Can be tilted to allow full exposure
Able to provide single, double and triple strength to babies without addition of further equipment

Cons:
Bulky - can be space consuming
If height is adjusted by accident, the possibility of baby not recieving enough phototherapy
Treatment must be stopped for feeding
Need to separate baby and mother which can potentially affect the bonding

35
Q

The use of a billboat is another phototherapy technique, what is the checklist for this?

A

With mains power cable attached
LED mattress
Mattress cover
Eye protection
Cot

36
Q

For the billboat used for phototherapy, list the pros and cons for it

A

Pros:
Greater exposure than blankets
Used LEDs as opposed to UV or infrared which reduces the risk of skin damage/fluid loss
Shut off function for elevated surface temperature - blocked air vent/increased ambient room temperature.
Allows for the use of covers and blankets for heat and containment

Cons:
Heavy and buoy in comparison to biliblankets
Cannot be used during feeding - hard surface, discomfort in comparison to overhead/biliblanket
One size fits all - larger term babies, difficult to position ideally

37
Q

What is the checklist for a biliblanket?

A

Phototherapy unit
Blanket pad attached to cable
Soft disposable blanket cover
Eye protecting mask
Cot

38
Q

For a biliblanket used for phototherapy treatment, what are the pros and cons?

A

Pros:
Babies on this piece of equipment can easily come out for S2S and feeding
Different sized pads and blankets are available for varying gestational ages
Can be offered out on loan to suitable patients whose parents wish to take their baby home on phototherapy and return to SCBU outpatient for review
The pad design helps eliminate distance discrepancies
Covers and blankets can be used over biliblankets

Cons:
Perhaps considered not as strong as overhead lights, therefore baby may require slightly lengthier treatments
No battery so must always plug into mains power

39
Q

What are the phototherapy concerns? What problems may they cause?

A

Thermal environment imbalance - thermoregulation issues are rare with LEDs
Maternal-infant interaction
Retinal damage - eye protection

40
Q

Phototherapy treatment can cause complications also, state what these are

A

Increased water loss - diarrhoea, electrolyte imbalance

Circadian rhythm disorder - sleep wake cycle disrupted

Bronze baby syndrome side effect due to poor liver function and cholestatis

Neonatal Intensive Care (10 decks)

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