Newborn Challenges: Hyperbilirubinemia and Hypoglycemia Flashcards
Why do newborns have a greater demand for glucose than adults and children?
Because of their large brain-to-body weight. The brain depends on glucose.
Define: glycogenolysis
Mobilization and release of glycogen from body stores to form glucose
Define: gluconeogenesis
Production of glucose by the liver and the kidneys from fatty acids and amino acids
In the immediate neonatal period glycogen stores are converted into glucose. How long to neonatal glycogen stores last?
90% depleted by 3 hours and gone by 12 hours.
List some symptoms of hypoglycemia
Jitteriness
Tremors
Feeding intolerance
Seizures
Apnea/bradycardia
Hypotonia
Hypothermia
Tachypnea/grunting
High pitched cry
Cyanosis
Which infants are at risk for neonatal hypoglycemia?
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
Blood glucose testing is performed on all infants, true or false.
False. Blood glucose testing should only be performed on at risk infants or infants with clinical signs.
What percentage of term/preterm infants develop jaundice within the first several days of birth
Term: 60%
Preterm: 80%
why are all infants tested for hyperbili by 48 hours old?
risk of kernicterous (neurotoxicity)
Define: conjugated bilirubin (direct)
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)
Define: unconjugated bilirubin (indirect)
occurs when the bilirubin is not yet attached to a glucuronide int he liver. Elevated levels of this form can cause neurotoxicity
Acute manifestations of BIND (Bilirubin induced neurologic dysfunction). When is it diagnosed as kernicterus?
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.
Maternal risk factors for neonatal hyperbili
Maternal diabetes
Poor milk transfer
Asian or hispanic
blood group incompatibilities or hemolytic diseases
sibling with neonatal jaundice
Newborn risk factors for neonatal hyperbili
sepsis
male
cephalohematoma
prematurity
trisomy 21
upper GI obstruction
swallowed maternal blood
acidosis
polycythemia
delayed bowel movements
hypothyroidism
when does physiologic jaundice occur?
2-5 days of life
when does pathologic jaundice occur?
Develops in the first 24 hours. Jaundice that occurs in this timeframe is always pathologic.
prolonged unconjugated hyperbili/”breast milk jaundince”
exact mechanism not known, presents in week 2 of life
sometimes treated by interruption in breastfeeding
suboptimal intake jaundice/”breastfeeding jaundice”
low consumption, infrequent bowel movements, so the body reabsorbs bili through enterohepatic circulation causing a build up.
