Neonatal Jaundice Flashcards
What is bilirubin?
Breakdown product of RBCs
What is the definition of hyperbilirubinemia?
Direct = >2 mg/dL
OR
Conjugated >20% of total
Jaundice is apparent at levels of bilirubin higher than what?
> 5 mg/dL
What are the 4 APP objectives for neonates and jaundice?
- Promote Breast feed
- Systemic assessment
- Provide early risk assessment
- Treat with phototherapy or exchange transfusion
What are the risk factors for neonatal jaundice (blood type, preterm/postterm, race, membranes, diseases, infx,)?
O- Preterm Asian Prolonged membrane rupture DM GBS
How do you differentiate between cyanosis and bruising?
Look inside the mouth
What are the risk factors for neonatal jaundice (3, gender, birthing process)?
Male gender
Vacuum/forceps
Excessive bruising
Why is it that the later you are born, the less of a risk there is of neonatal jaundice?
Matured liver
What is the appropriate place to use the vacuum for birthing?
Occiput
When should jaundice occur, if it does?
2-5 day, occurs in 50% of neonates
When after birth is jaundice concerning? Why?
within the 1st day of birth
Kernicterus causing MR
What part of the brain does bili accumulate?
Basal ganglia
Beside the liver’s inability to conjugate RBCs in the neonate, what is the cause of jaundice?
Hemolysis of RBCs
What is the RBC life in the newborn?
80 days
What are the two physiologic stores of bilirubin if the liver is overwhelmed?
Blood and skin
What are the exclusion criteria of physiologic jaundice? (Unconjugated bilirubin levels in term and preterm babies)
Unconjugated > 13 mg/dL in term,
or
> 15 mg/dL in term
How long does physiologic jaundice last in term and preterm infants?
Less than 1 week in term
Less than 2 weeks in preterm
What is blueberry muffin baby? What causes this?
Congenital rubella
Extramedullary sites of hematopoiesis
What is the rate of bilirubin level increase that is concerning?
Greater than 5 mg/dl/24hours
What is the cause of breast feeding jaundice?
Lack of calories in breast feeding, this not excreting enough bilirubin
How do you treat breast feeding jaundice?
Breast feed often
What supplements have been shown to worsen breast feeding jaundice?
Glucose water or water
What is the cause of ABO incompatibility in neonates?
Crossing of blood from mother to baby, causing breakdown of baby’s RBCs, causing jaundice
What is the antibody type that is seen with ABO incompatibility?
IgG
What is the test for immune hemolytic anemia?
Direct Coombs test
Is Rh incompatibility more or less common than ABO incompatibility? More of less severe?
Less common
More severe
What is the result of Rh incompatibility?
Hydrops fetalis or encephalopathy
What is rhogam?
Passive IgG immunization for rh +
What is breast MILK jaundice? What is the treatment for this?
Increased enterohepatic recirculation of bilirubin secondary to a LCFA “factor” (unknown) in human breast milk that promotes intestinal absorption
Self limiting, or can switch to formula for 2 days to watch it go down
What are the diagnostic criteria for breast milk jaundice?
Well baby, 2nd week of life, breast feeding well
What is pyruvate kinase deficiency?
Decrease level of pyruvate kinase leads to early destruction of RBCs
What is type I crigler-Najjar syndrome?
Lack of UGT
No response to phenobarb
What is type II crigler-Najjar syndrome?
Decreased UGT
Some response to phenobarb
How does jaundice progress?
Head to toe
Is visual estimation good for hyperbilirubinemia?
Nope
What levels of bilirubinemia causes the appearance of jaundice?
5-6 mg/dL
How do you assess for jaundice?
Blood specimen or spectrophotometer
What is infant life measured in for determining what to do with jaundice?
Hours
What is a nomogram?
Graph that determines that risk of neonatal jaundice, and the timeframe for f/u
When should f/u be with a risk zone of low to high intermediate?
2-3 days
When should f/u be with a risk zone of high?
24 hours
What is phototherapy for hyperbilirubinemia?
Blue-green light that causes indirect bilirubin to open up and become soluble–DOES NOT conjugate bilirubin
What are the risks of phototherapy? (2)
Retinal degeneration
Increased fluid loss
What happens when bili lights are used for conjugated bilirubin? (Bronze baby syndrome)
May cause photo destruction of copper porphyrins, causing urine and skin to become bronze
What is congenital erythropoietic porphyria?What is the effect of phototherapy with these kids?
Rare enzymatic defect in uroporphyrin synthase
If baby is exposed to phototherapy, may cause severe bullous lesions on exposed skin = death
Do you need supplemental fluids with phototherapy?
No
When do you discontinue bili lights?
Not set guidlines
Do you need to follow serum bilirubin after discontinuation of phototherapy?
No
Can a mother stop phototherapy for breast feeding?
Yes
What is the treatment for polycythemia vera?
Exchange transfusion with D5
What is the alternative treatment for hyperbilirubinemia if bili lights are not possible?
Exchange transfusion with blood
Conjugated bili above what level is concerning in infants?
Greater than 2 mg/dL
True or false: HSM is common in physiologic jaundice
False
True or false: pallor or plethora is not a part of physiologic jaundice
True
