NEONATOLOGY

Question 1

In a baby with PHYSIOLOGIC jaundice, what would you expect in terms of onset, resolution, type of bili, and speed of bili rise?

Answer 1

Onset - >72 hrs
Resolution - <1wk (<2 primi)
Bili - unconjugated
Rise - < 5 pts/day

Question 2

In a baby with PATHOLOGIC jaundice, what would you expect in terms of onset, resolution, type of bili, and speed of bili rise?

Answer 2

Onset - <24 hrs
Resolution - >1wk (>2 primi)
Bili - conjugated
Rise - < 5 pts/day

Question 3

What are the most common causes of unconjugated hyperbilirubinemia (jaundice)? Are issues generally pre-, post, or intra- hepatic?

Answer 3

• hemolysis
• hemorrhage/hematomas
• unconjugated = PRE

Question 4

What are the most common causes of conjugated hyperbilirubinemia (jaundice)? Are issues generally pre-, post, or intra- hepatic?

Answer 4

• biliary atresia
• sepsis
• metabolic issues

conjugated = POST

Question 5

Describe your approach to assessing UNconjugated hyperbili (jaundice).

Answer 5

COOMBS:
if + = isoimmunization
if - = check Hgb

Hgb:
high = transfusion
low = hemorrhage
N = check Retic

Retic:
high = hemolysis
N = Dx:Reabsorption  
--> Breast feeding or Breast Milk problem, either way..
Tx = feed w/ hydrolyzed formula

Question 6

What are the normal changes in bilirubin levels in a full-term newborn?

Answer 6

• start w/ avg of 35mmol/L
• serum levels rise and peak at 85 - 100 b/t 60-72 hrs of life.
• DAY 5: most healthy infants are <210 (bottle def) - <260 (breast fed)

Question 7

What factors suggest hemolytic disease as a cause of jaundice in the newborn? (8)

Answer 7

• FMHx of hemolytic disease
• bili rise > 5/day
• phototherapy didn’t help lower serum bili
• onset of jaundice <24 hrs
• reticulocytosis (high retic)
• significant dec in Hgb
• pallor
• hepatosplenomegally

Question 8

What is the main condition we try to prevent in newborns with jaundice?

Answer 8

Kernicterus