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Gastrointestinal > Neonatal Jaundice > Flashcards

Neonatal Jaundice Flashcards

1
Q

What is bilirubin?

A

Breakdown product of RBCs

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2
Q

What is the definition of hyperbilirubinemia?

A

Direct = >2 mg/dL
OR
Conjugated >20% of total

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3
Q

Jaundice is apparent at levels of bilirubin higher than what?

A

> 5 mg/dL

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4
Q

What are the 4 APP objectives for neonates and jaundice?

A
  1. Promote Breast feed
  2. Systemic assessment
  3. Provide early risk assessment
  4. Treat with phototherapy or exchange transfusion
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5
Q

What are the risk factors for neonatal jaundice (blood type, preterm/postterm, race, membranes, diseases, infx,)?

A 
O-
Preterm
Asian
Prolonged membrane rupture
DM
GBS
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6
Q

How do you differentiate between cyanosis and bruising?

A

Look inside the mouth

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7
Q

What are the risk factors for neonatal jaundice (3, gender, birthing process)?

A

Male gender
Vacuum/forceps
Excessive bruising

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8
Q

Why is it that the later you are born, the less of a risk there is of neonatal jaundice?

A

Matured liver

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9
Q

What is the appropriate place to use the vacuum for birthing?

A

Occiput

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10
Q

When should jaundice occur, if it does?

A

2-5 day, occurs in 50% of neonates

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11
Q

When after birth is jaundice concerning? Why?

A

within the 1st day of birth

Kernicterus causing MR

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12
Q

What part of the brain does bili accumulate?

A

Basal ganglia

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13
Q

Beside the liver’s inability to conjugate RBCs in the neonate, what is the cause of jaundice?

A

Hemolysis of RBCs

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14
Q

What is the RBC life in the newborn?

A

80 days

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15
Q

What are the two physiologic stores of bilirubin if the liver is overwhelmed?

A

Blood and skin

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16
Q

What are the exclusion criteria of physiologic jaundice? (Unconjugated bilirubin levels in term and preterm babies)

A

Unconjugated > 13 mg/dL in term,

or

> 15 mg/dL in term

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17
Q

How long does physiologic jaundice last in term and preterm infants?

A

Less than 1 week in term

Less than 2 weeks in preterm

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18
Q

What is blueberry muffin baby? What causes this?

A

Congenital rubella

Extramedullary sites of hematopoiesis

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19
Q

What is the rate of bilirubin level increase that is concerning?

A

Greater than 5 mg/dl/24hours

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20
Q

What is the cause of breast feeding jaundice?

A

Lack of calories in breast feeding, this not excreting enough bilirubin

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21
Q

How do you treat breast feeding jaundice?

A

Breast feed often

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22
Q

What supplements have been shown to worsen breast feeding jaundice?

A

Glucose water or water

23
Q

What is the cause of ABO incompatibility in neonates?

A

Crossing of blood from mother to baby, causing breakdown of baby’s RBCs, causing jaundice

24
Q

What is the antibody type that is seen with ABO incompatibility?

A

IgG

25
Q

What is the test for immune hemolytic anemia?

A

Direct Coombs test

26
Q

Is Rh incompatibility more or less common than ABO incompatibility? More of less severe?

A

Less common

More severe

27
Q

What is the result of Rh incompatibility?

A

Hydrops fetalis or encephalopathy

28
Q

What is rhogam?

A

Passive IgG immunization for rh +

29
Q

What is breast MILK jaundice? What is the treatment for this?

A

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

30
Q

What are the diagnostic criteria for breast milk jaundice?

A

Well baby, 2nd week of life, breast feeding well

31
Q

What is pyruvate kinase deficiency?

A

Decrease level of pyruvate kinase leads to early destruction of RBCs

32
Q

What is type I crigler-Najjar syndrome?

A

Lack of UGT

No response to phenobarb

33
Q

What is type II crigler-Najjar syndrome?

A

Decreased UGT

Some response to phenobarb

34
Q

How does jaundice progress?

A

Head to toe

35
Q

Is visual estimation good for hyperbilirubinemia?

A

Nope

36
Q

What levels of bilirubinemia causes the appearance of jaundice?

A

5-6 mg/dL

37
Q

How do you assess for jaundice?

A

Blood specimen or spectrophotometer

38
Q

What is infant life measured in for determining what to do with jaundice?

A

Hours

39
Q

What is a nomogram?

A

Graph that determines that risk of neonatal jaundice, and the timeframe for f/u

40
Q

When should f/u be with a risk zone of low to high intermediate?

A

2-3 days

41
Q

When should f/u be with a risk zone of high?

A

24 hours

42
Q

What is phototherapy for hyperbilirubinemia?

A

Blue-green light that causes indirect bilirubin to open up and become soluble–DOES NOT conjugate bilirubin

43
Q

What are the risks of phototherapy? (2)

A

Retinal degeneration

Increased fluid loss

44
Q

What happens when bili lights are used for conjugated bilirubin? (Bronze baby syndrome)

A

May cause photo destruction of copper porphyrins, causing urine and skin to become bronze

45
Q

What is congenital erythropoietic porphyria?What is the effect of phototherapy with these kids?

A

Rare enzymatic defect in uroporphyrin synthase

If baby is exposed to phototherapy, may cause severe bullous lesions on exposed skin = death

46
Q

Do you need supplemental fluids with phototherapy?

A

No

47
Q

When do you discontinue bili lights?

A

Not set guidlines

48
Q

Do you need to follow serum bilirubin after discontinuation of phototherapy?

A

No

49
Q

Can a mother stop phototherapy for breast feeding?

A

Yes

50
Q

What is the treatment for polycythemia vera?

A

Exchange transfusion with D5

51
Q

What is the alternative treatment for hyperbilirubinemia if bili lights are not possible?

A

Exchange transfusion with blood

52
Q

Conjugated bili above what level is concerning in infants?

A

Greater than 2 mg/dL

53
Q

True or false: HSM is common in physiologic jaundice

A

False

54
Q

True or false: pallor or plethora is not a part of physiologic jaundice

A

True

Gastrointestinal (42 decks)

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