Neonatal Jaundice Flashcards

1
Q

What are the lab values and presentation that is consistent with physiologic jaundice?

A

onset after 1st day, peaking at 3-5d
excess bilirubin is unconjuated, peaks at 12-15mg/dL
clinical resolution by 1wk

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2
Q

What are the lab values and presentation that is consistent with breast-milk jaundice?

A

peaks at 10-15d thought to be due to some unknown inhibitor (UGT inhibit?) in breast milk, corrects with trial of formula

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3
Q

What are two causes of extreme unconjugated hyperbilirubenmia of infancy.

A

defects of glucuronidation: Gilberts, Crigler-Najjar
hemolysis

consider treatment with phototherapy, exchange transfusion for bilirubin >20-25 (and even lower levels in premature infants) due to danger of kernicterus

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4
Q

What are two causes of extreme conjugated hyperbilirubenmia of infancy.

A
defects in handling or export of conjugated bilirubin: Rotor or Dubin Johnson (no signs liver injury)
hepatocyte injury (increased ALT, AST)
biliary obstruction (increased GGT)
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5
Q

What conditions could dispose an infant to severe unconjugated hyperbilirubinemia?

A
ABO incompatibility
G6PD deficiency
prematurity
chephalhematoma/bruising
exclusive breastfeeding
east asian background
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6
Q

Is jaundice with onset <24h of age pathological?

A

yes, requires urgent evaluation, consider hemolytic disease

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7
Q

What is the evaluation required of a newborn with prolonged jaundice?

A

fractionated bilirubin levels
liver enzyme levels
+ additional tests for surgical exploration

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8
Q

What are possible causes of (prolonged) conjugated hyperbilirubinemia in the neonate?

A

extra hepatic biliary atresia (30-35%)
idiopathic neonatal hepatitis (30-35%)
metabolic/genetic (15%)
intrahepatic cholestasis, abnormal bile ducts (5%)
non-bacterial infection (5%) CMV, rubella, HSV, toxoplasma

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9
Q

What is the classic EHBA classic presentation?

A
healthy term infant with prolonged jaundice
echoic stools, weight gains slows
high conjugated bile
increased ALP, GGT> AST, ALT
can be accompanied portal HTN

should be evaluated (absence of gallbladder is a hint) with ultrasound and biopsy (bile plugs and duct proliferation)

fatal by 8-12 mo without surgery (Kasai procedure, best outcome by 7-8wks)

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