Neonatal Unconjugated Hyperbilirubinemia

Question 1

What is Bilirubin?

Answer 1

A breakdown product of RBCs

A Yellow Pigment.

Question 2

What defines Conjugated hyperbilirubinemia?

Answer 2

Serum conjugated bili >2 mg/dl or >20%of total

Question 3

When is Jaundice visible?

Answer 3

bilirubin >5mg/dl

Question 4

How does gestational age play into jaundice risk?

Answer 4

More term= less risk of jaundice

Question 5

What age should you be concerend vs unconcered about jaundice?

Answer 5

1 day concerned!

2-5 day not as concerened

Question 6

Where does bilirubin accumulate in the brain?

Answer 6

Basal ganglia (kernicterus)
Bilirubin encephalopathy

Question 7

How long is the RBC Lifespan in newborns?

Answer 7

80 days!

Question 8

At what point is Bilirubin too high to be considered physiologic jaundice?

Answer 8

unconjugated bili >13mg/dl in term infant
unconjugated bili >15mg/dl in preterm infant
Increase greater than 5mg/dl/24hrs
Clinical jaundice lasting >1 week in term infants and > 2 weeks in preterm infants

Question 9

How is Breast feeding jaundice resolved?

Answer 9

Frequent feeding

Question 10

Does supplementing with water help with breastfeeding jaundice?

Answer 10

No! Makes it worse!

Question 11

What is the most common cause of hemolytic disease of the newborn?

Answer 11

ABO incompatibility.

mom is O and baby is A or B

Question 12

What causes Rh incompatibility in infants?

Answer 12

Mom is Rh- and dad/baby is Rh+

Antibodies produced toward Rh antigens

Question 13

What is Breast Milk jaundice?

Answer 13

Something in Breastmilk (LCFA) that increases intestinal absorption of bilirubin.

Question 14

What is treatment for Breast Milk jaundice?

Answer 14

Nothing, it will go away by itself. Can switch to formula for 2 days and it won’t recurr when you switch back on.

Question 15

What is the puropose of Phenobarbitol?

Answer 15

Revvs up UGT. Doesn’t work on CN type 1.

Question 16

How can bilirubin be measured?

Answer 16

Bilimeter is a good screening tool.

Blood specien

Question 17

What does a nomogram tell us?

Answer 17

Graph that tells us the relative risk of jaundice continuing after going home based on Bili and hours after birth.

Question 18

How do we know when to start phototherapy?

Answer 18

A separate nomogram. Don’t start until over a specific line(depends on gestational age).

Question 19

How does phototherapy take the bilirubin down?

Answer 19

UV lights help make bilirubin water soluable

Question 20

What are the risks of phototherapy?

Answer 20

Retinal degeneration
Insensitive fluid loss
Bronze baby syndrome with CONJUGATED bilirubin.
Congenital Erythropoetic Porphyria (skin thickens and vesicles form. skin is sensitive to UV light)

Question 21

When is an exchange transfusion indicated?

Answer 21

When phototherapy is failing to control rise in bilirubin.

Question 22

What is done in Exchange Transfusion?

Answer 22

Remove bili-full blood and replace with donor blood. Only in NICU or PICU (