Neonatal Unconjugated Hyperbilirubinemia Flashcards
What is Bilirubin?
A breakdown product of RBCs
A Yellow Pigment.
What defines Conjugated hyperbilirubinemia?
Serum conjugated bili >2 mg/dl or >20%of total
When is Jaundice visible?
bilirubin >5mg/dl
How does gestational age play into jaundice risk?
More term= less risk of jaundice
What age should you be concerend vs unconcered about jaundice?
1 day concerned!
2-5 day not as concerened
Where does bilirubin accumulate in the brain?
Basal ganglia (kernicterus) Bilirubin encephalopathy
How long is the RBC Lifespan in newborns?
80 days!
At what point is Bilirubin too high to be considered physiologic jaundice?
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
How is Breast feeding jaundice resolved?
Frequent feeding
Does supplementing with water help with breastfeeding jaundice?
No! Makes it worse!
What is the most common cause of hemolytic disease of the newborn?
ABO incompatibility.
mom is O and baby is A or B
What causes Rh incompatibility in infants?
Mom is Rh- and dad/baby is Rh+
Antibodies produced toward Rh antigens
What is Breast Milk jaundice?
Something in Breastmilk (LCFA) that increases intestinal absorption of bilirubin.
What is treatment for Breast Milk jaundice?
Nothing, it will go away by itself. Can switch to formula for 2 days and it won’t recurr when you switch back on.
What is the puropose of Phenobarbitol?
Revvs up UGT. Doesn’t work on CN type 1.
How can bilirubin be measured?
Bilimeter is a good screening tool.
Blood specien
What does a nomogram tell us?
Graph that tells us the relative risk of jaundice continuing after going home based on Bili and hours after birth.
How do we know when to start phototherapy?
A separate nomogram. Don’t start until over a specific line(depends on gestational age).
How does phototherapy take the bilirubin down?
UV lights help make bilirubin water soluable
What are the risks of phototherapy?
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)
When is an exchange transfusion indicated?
When phototherapy is failing to control rise in bilirubin.
What is done in Exchange Transfusion?
Remove bili-full blood and replace with donor blood. Only in NICU or PICU (
