Neonatal jaundice Flashcards
define conjugated hyperbilirubinemia:
- serum conjugated/direct bilirubin >2mg/dL
- serum conjugated bilirubin >20% of total
Risk factors that predispose infants to hyperbilirubinemia:
-infection-fever mother at delivery
-pre-mature
-diabetes mother
hereditary
-vacuum assisted + forcepts delivery
-breast feeding
-asian race
-O blood type mother
-Rh neg mother
-the younger the baby the higher the risk
when does jaundice usually occur in the newborn?
- 2nd to 5th day of life
- 50-60% of newborns get this
Why worry about severe unconjugated hyperbilirubinemia?
-indirect (UC) bilirubin is neurotoxic and causes a whole bunch of issues
KERNICTERUS - basalganlia, hippocampus….
describe physiologic jaundice:
- failure of the liver to dispose of normal amounts of biliruibn produced by the breakdown of the newborns red blood cell with accumulation in the blood stream and skin (transition from HbF to HbA)
- occurs 2nd to 5th day of life
How do you know if its not physiologic jaundice?
- *happens in the first 24 hours of life
- lasts longer than 2 weeks in preterms or 1 week in term infants
- UC>13mg/dL in term or UC>15mg/dL in preterm
- if bilirubin increasing >5mg/dL/24 hrs
Define pathologic jaundice:
(physical findings)
- pallor or plethora (bloody deep red look = ppolycythemia)
- petechia or bruising
- blueberry muffin lesions
- cataracts
- goiter
- HSM
- abnormal tone
- abd mass
Breast feeding jaundice
- physiologic/pathologic?
- describe some stuff?
- pathologic
- nutritional deficiency - bc of calories
***CALORIC ISSUE
ABO incompatibility-describe the situation:
-baby is A or B and mom is O
-baby fetal blood cells get into maternal circulation (leakage)
-mothers body makes antibodies against foreign RBC (IgG)
==> IgG crosses placenta –> breakdown of babies RBCs
Check for ABO incompatibitly wth what test?
direct coombs test on mothers blood
Rh Incompatibility - describe:
- more severe than ABO incomp
- worsens with each pregnancy
- Rh neg mom
- Rh pos baby
- leakage of baby cells = maternal IgG against Rh factor –> destruction of baby RBCs
list methods to screen for hyperbilirubinemia:
- visually: not the best since it can be hard to distinguish sometimes
- bilimeter: skin test without even poking the baby (TcB)
- serum bilirubin (TSB) - need to poke the baby
tx of choice for hyperbilirubinemia?
phototherapy
Most common risk of phototherapy?
retinal degeneration - we cover the eyes to prevent this
If phototherapy is not working?
-exchange transfusion - take baby blood out and give baby different blood
