Newborn Challenges: Hyperbilirubinemia and Hypoglycemia

Question 1

Why do newborns have a greater demand for glucose than adults and children?

Answer 1

Because of their large brain-to-body weight. The brain depends on glucose.

Question 2

Define: glycogenolysis

Answer 2

Mobilization and release of glycogen from body stores to form glucose

Question 3

Define: gluconeogenesis

Answer 3

Production of glucose by the liver and the kidneys from fatty acids and amino acids

Question 4

In the immediate neonatal period glycogen stores are converted into glucose. How long to neonatal glycogen stores last?

Answer 4

90% depleted by 3 hours and gone by 12 hours.

Question 5

List some symptoms of hypoglycemia

Answer 5

Jitteriness
Tremors
Feeding intolerance
Seizures
Apnea/bradycardia
Hypotonia
Hypothermia
Tachypnea/grunting
High pitched cry
Cyanosis

Question 6

Which infants are at risk for neonatal hypoglycemia?

Answer 6

SGA
LGA
low birth weight
Infants to mothers with diabetes
preterm infants
perinatal stress
discordant twin
cold stress
exposed to meds in labour that decrease glucose (oral hypoglycemics, terbutaline, propranolol)
any infant not feeding well

Question 7

Blood glucose testing is performed on all infants, true or false.

Answer 7

False. Blood glucose testing should only be performed on at risk infants or infants with clinical signs.

Question 8

What percentage of term/preterm infants develop jaundice within the first several days of birth

Answer 8

Term: 60%
Preterm: 80%

Question 9

why are all infants tested for hyperbili by 48 hours old?

Answer 9

risk of kernicterous (neurotoxicity)

Question 10

Define: conjugated bilirubin (direct)

Answer 10

occurs when bilirubin is attached to glucuronide by an enzymatic process in the liver. Elevated levels are NOT neurotoxic by may be indicative of a more serious illness (ex: hepatitis)

Question 11

Define: unconjugated bilirubin (indirect)

Answer 11

occurs when the bilirubin is not yet attached to a glucuronide int he liver. Elevated levels of this form can cause neurotoxicity

Question 12

Acute manifestations of BIND (Bilirubin induced neurologic dysfunction). When is it diagnosed as kernicterus?

Answer 12

Lethargy, hypotonia, seizures, high pitched cry, poor feeding, loss of Moro reflex.

Kernicterus is diagnosed when there are chronic or permanent symptoms of BIND, including sensorineural hearing loss, upward gaze palsy, dental enamel dysplasia, cerebral palsy, cognitive impairment.

Question 13

Maternal risk factors for neonatal hyperbili

Answer 13

Maternal diabetes
Poor milk transfer
Asian or hispanic
blood group incompatibilities or hemolytic diseases
sibling with neonatal jaundice

Question 14

Newborn risk factors for neonatal hyperbili

Answer 14

sepsis
male
cephalohematoma
prematurity
trisomy 21
upper GI obstruction
swallowed maternal blood
acidosis
polycythemia
delayed bowel movements
hypothyroidism

Question 15

when does physiologic jaundice occur?

Answer 15

2-5 days of life

Question 16

when does pathologic jaundice occur?

Answer 16

Develops in the first 24 hours. Jaundice that occurs in this timeframe is always pathologic.

Question 17

prolonged unconjugated hyperbili/”breast milk jaundince”

Answer 17

exact mechanism not known, presents in week 2 of life

sometimes treated by interruption in breastfeeding

Question 18

suboptimal intake jaundice/”breastfeeding jaundice”

Answer 18

low consumption, infrequent bowel movements, so the body reabsorbs bili through enterohepatic circulation causing a build up.