Neonatal Jaundice OME

Question 1

which type of bilirubin can cross the BBB? what can this cause in a neonate?

Answer 1

unconjugated bilirubin/indirect bilirubin = lipid soluble can cause life-threatening Kernicterus(in baby only bc brain is sitll developing) = bilirubin deposits in basal ganglia and pons

Question 2

if you have jaundice which type of bilirubin do u want to have(better of two evils)? why?

Answer 2

conjugated/direct! bc this will not cross the BBB & can be peed out.

Question 3

can adults get kernicterus?

Answer 3

nope! effects babies bc brain is still developing

Question 4

physiologic jaundice vs. pathologic jaundice

Answer 4

physiologic(uncon): 1-7 days onset, slow rise, <10% direct bili, resolves by day 10

Pathologic(conj): <24h onset, rapid rise, direct bili >20%, lasts >2 wks

Question 5

baby w/jaundice, elevated unconj/indirect bili, coombs +. dx?

Answer 5

Isoimmunization = Rh Dz or ABO incompatability

Question 6

baby w/jaundice, elevated unconjugated bili, coombs -, hgb high. dx?

Answer 6

blood transfusion! = twin-twin transfusion syndrome, material-baby transfusion, delayed cord clamping

Question 7

baby w/jaundice, elevated unconjugated bili, coombs -, hgb low, rectic count high. dx?

Answer 7

hemolysis! = spherocytosis, G6PD def, Pyruvate kinase def, hematoma bleed, ccephalohematoma

Question 8

baby w/jaundice, elevated unconjugated bili, coombs -, hgb low/normal, rectic count normal. dx?

Answer 8

reabsorption prob! = hemorrhage, breast feeding jaundice, breast milk jaundice

Question 9

Breast feeding jaundice

Answer 9

baby isnt being fed enough = decrease bowel movment = baby reabsorbes crap(conjugated bilirubin) = turns yellow

Question 10

breast milk jaundice

Answer 10

moms milk isnt allowing conjucation of bilirubin = elevated unconjugated bilirubin! = switch to formula for a bit then can go back to breastfeeding.

Question 11

Physiologic jaundice vs beastmilk vs biliary atresia

Answer 11

1. Physiologic jaundice: CONJUGATED within 24hr
2. Breast milk jaundice: UNCONJ/indirect in 2nd week
3. Biliary atresia: initially ok then within 2m develops CONJ bili