neonate jaundice test 2 Flashcards
some knowledge i have from having a kid:
baby feeding
feed that little shit till he can’t move (milk drunk) ((it is real))
it is hard to over feed a neonate
breast and milk
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
t/f All newborns experience some degree of jaundice
t
t/f Unbound (free) bilirubin can not cross the blood-brain barrier
f it fucking can
t/f bilirubin is a neuro toxin
t
how often do you exam for jaundice
8 - 12 hrs head to toe
what hours do you check serum bili
24 and 36
r/f for jaundice
Pallor Petechiae Cephalohematoma Bruising Hepatosplenomegaly Weight loss Dehydration Sepsis
an increase number of ____ increases production of bili
rbc (the answer is not sperm Dylan!)
a low level of enzyme ___ in the ___ decreases bili clearance
UGT1A1, liver
increased enterohepatic circulation of bilirubin is caused by what
no gut bacteria
what is physiologic jaundice
Jaundice visible after 24 hours of age
Total bilirubin peak does not require treatment
Due to elevated indirect (unconjugated) bilirubin
t/f east asian newborns have a higher peak total bili
t , it is normal
______exacerbates the increased production of bilirubin
hemolysis
these conditions cause hemolysis
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)
remember that enzyme UGT1A1 in the liver… what causes that
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)
causes increased enterohepatic circulation = jaundice (on last test= not nice)
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
to sum those up what are the three causes of indirect hyperbilirubinemia
increased production (hemolysis)
decreased clearance (UGT1A1 not working or not there)
increased enterohepatic circulation (titty milk thing or blocked bowel thing)
signs of direct hyperbilirubinemia (cholestasis)
Jaundice, pale stools, dark urine
Direct hyperbilirubinemia is caused by?
Hepatitis
Endocrinopathy (hypothyroid)
Inborn errors of metabolism
Alpha-1 antitrypsin deficiency
Total parenteral nutrition (=biliary sludging)
Sepsis
Biliary atresia (bile cant get out)
what procedure does biliary atresia need (sorry for the douche question)
kasai procedure
what does primiparous mean
first prego
criteria for direct hyperbilirubinemia (math it hint hint)
Direct bilirubin > 1.0 mg/dL if TsB < 5.0 mg/dL
Direct bilirubin > 20% of TsB if TsB > 5.0 mg/dL
what does the Bhutani nomogram compare
total serum bili to hours alive
what protection does baby need for phototherapy
diaper and eye protection
explain what phototherapy does to the parent (it does it to the baby but tell parent)
isomerize bilirubin to a water soluble form that can be excreted into the urine
when does the infant have to be under the light
continuously, except for feedings and diaper changes (baby tanning)
what does the phototherapy guide tell us
when to stop and start (compares total Serum bili and hours alive)
high risk pt guideline
(i.e., gestational age 35 weeks 0 days to 37 weeks 6 days who have additional risk factors
medium risk pt guideline
(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)
low risk (top line)
(i.e., gestational age 38 weeks 0 days and older who are and well)
pt additional risk factors
-isoimmune hemolytic disease
G6PD deficiency
asphyxia, significant lethargy, temperature instability, sepsis, acidosis
albumin <3.0 mg/d
what do you do if you suspect ABO incompatibility
initiate phototherapy first and then obtain a CBC and peripheral smear
when do you check TsB with photo therapy
2-4 hours
8-12
when do you stop photo therapy
when TsB below starting level
when do you check for rebound TsB and what is a fast rate of rebound
4 hours
Quick rate of rise is greater than 0.2 mg/dL per hour
Difference between physiologic and pathologic newborn jaundice
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
When newborn jaundice requires treatment
Direct hyperbilirubinemia always requires treatment
When indirect bilirubin is at or within 3 points of the phototherapy threshold
