neonate jaundice test 2

Question 1

some knowledge i have from having a kid:

baby feeding

Answer 1

feed that little shit till he can’t move (milk drunk) ((it is real))

it is hard to over feed a neonate

Question 2

breast and milk

Answer 2

that shit will hurt! drain it, feed the kiddo, pump, compresses are legit, nipple shield (kk had all her teeth by 12 months (no nipple shield = no nipples

Question 3

t/f All newborns experience some degree of jaundice

Answer 3

t

Question 4

t/f Unbound (free) bilirubin can not cross the blood-brain barrier

Answer 4

f it fucking can

Question 5

t/f bilirubin is a neuro toxin

Answer 5

t

Question 6

how often do you exam for jaundice

Answer 6

8 - 12 hrs head to toe

Question 7

what hours do you check serum bili

Answer 7

24 and 36

Question 8

r/f for jaundice

Answer 8

Pallor
Petechiae
Cephalohematoma
Bruising
Hepatosplenomegaly
Weight loss
Dehydration
Sepsis

Question 9

an increase number of ____ increases production of bili

Answer 9

rbc (the answer is not sperm Dylan!)

Question 10

a low level of enzyme ___ in the ___ decreases bili clearance

Answer 10

UGT1A1, liver

Question 11

increased enterohepatic circulation of bilirubin is caused by what

Answer 11

no gut bacteria

Question 12

what is physiologic jaundice

Answer 12

Jaundice visible after 24 hours of age
Total bilirubin peak does not require treatment
Due to elevated indirect (unconjugated) bilirubin

Question 13

t/f east asian newborns have a higher peak total bili

Answer 13

t , it is normal

Question 14

______exacerbates the increased production of bilirubin

Answer 14

hemolysis

Question 15

these conditions cause hemolysis

Answer 15

Hemolytic Disease of the Fetus and Newborn
Heritable red blood cell membrane defects
Red blood cell enzyme defects
Sepsis
Polycythemia (lots of rbc)
Cephalohematoma (bone bruise)
Macrosomia (big baby)

Question 16

remember that enzyme UGT1A1 in the liver… what causes that

Answer 16

Crigler-Najjar Syndrome Type 1 (no function)

Crigler Najjar Syndrome Type 2 (some function)

Gilbert Syndrome - (most common least severe)

Infant of a diabetic mother

Congenital hypothyroidism

Galactosemia (cant catabolize glactose)

Question 17

causes increased enterohepatic circulation = jaundice (on last test= not nice)

Answer 17

Breast milk jaundice
Due to an unknown substance in breastmilk
Presents after first week of life
Resolves by 12 weeks
Continue breastfeeding

Breastfeeding jaundice
Deficient breastfeeding
Presents during first week of life
Consider temporary supplementation with banked human milk or formula

Intestinal obstruction or ileus

Question 18

to sum those up what are the three causes of indirect hyperbilirubinemia

Answer 18

increased production (hemolysis)

decreased clearance (UGT1A1 not working or not there)

increased enterohepatic circulation (titty milk thing or blocked bowel thing)

Question 19

signs of direct hyperbilirubinemia (cholestasis)

Answer 19

Jaundice, pale stools, dark urine

Question 20

Direct hyperbilirubinemia is caused by?

Answer 20

Hepatitis

Endocrinopathy (hypothyroid)

Inborn errors of metabolism

Alpha-1 antitrypsin deficiency

Total parenteral nutrition (=biliary sludging)

Sepsis

Biliary atresia (bile cant get out)

Question 21

what procedure does biliary atresia need (sorry for the douche question)

Answer 21

kasai procedure

Question 22

what does primiparous mean

Answer 22

first prego

Question 23

criteria for direct hyperbilirubinemia (math it hint hint)

Answer 23

Direct bilirubin > 1.0 mg/dL if TsB < 5.0 mg/dL

Direct bilirubin > 20% of TsB if TsB > 5.0 mg/dL

Question 24

what does the Bhutani nomogram compare

Answer 24

total serum bili to hours alive

Question 25

what protection does baby need for phototherapy

Answer 25

diaper and eye protection

Question 26

explain what phototherapy does to the parent (it does it to the baby but tell parent)

Answer 26

isomerize bilirubin to a water soluble form that can be excreted into the urine

Question 27

when does the infant have to be under the light

Answer 27

continuously, except for feedings and diaper changes (baby tanning)

Question 28

what does the phototherapy guide tell us

Answer 28

when to stop and start (compares total Serum bili and hours alive)

Question 29

high risk pt guideline

Answer 29

(i.e., gestational age 35 weeks 0 days to 37 weeks 6 days who have additional risk factors

Question 30

medium risk pt guideline

Answer 30

(i.e., gestational age of 38 weeks 0 days and older who have additional risk factors -or- gestational age 35 weeks 0 days to 37 weeks 6 days and well)

Question 31

low risk (top line)

Answer 31

(i.e., gestational age 38 weeks 0 days and older who are and well)

Question 32

pt additional risk factors

Answer 32

-isoimmune hemolytic disease G6PD deficiency asphyxia, significant lethargy, temperature instability, sepsis, acidosis albumin <3.0 mg/d

Question 33

what do you do if you suspect ABO incompatibility

Answer 33

initiate phototherapy first and then obtain a CBC and peripheral smear

Question 34

when do you check TsB with photo therapy

Answer 34

2-4 hours | 8-12

Question 35

when do you stop photo therapy

Answer 35

when TsB below starting level

Question 36

when do you check for rebound TsB and what is a fast rate of rebound

Answer 36

4 hours Quick rate of rise is greater than 0.2 mg/dL per hour

Question 37

Difference between physiologic and pathologic newborn jaundice

Answer 37

Begins after 24 hours of age; peak bilirubin not high enough to require treatment; due to elevated unconjugated bilirubin; self-resolves by 2-3 weeks of age

Question 38

When newborn jaundice requires treatment

Answer 38

Direct hyperbilirubinemia always requires treatment | When indirect bilirubin is at or within 3 points of the phototherapy threshold