newborn complications Flashcards
hyperbilirubmia is caused by
not enough albumin
bilirubin escaping liver
what is bilirubin
yellow bile pigment produced by the breakdown of rbc
function of albumin
transport bilirubin
prevent bilrubin from escaping into vascular space and prevents it from being into tissues
what takes bilrubin to liver
albumin
how does bilirubin get in liver
disffuse and endocytosis
what makes bilirubin soluble
glucuronyl transferase
- congualted
why cant bilirubun be reabsorbed once its cogugated
it gets bigger
issues with NB that cause jaundice
immature livers
faulty process
binding sites are low in supply
what gives yellow colour
biliruin getting into tissues
billirubin in brain
neurotoxicity
what needs to be working well to prevent too much bilirubin issues
GI, get bilirubin leaving! encourage bf
what is a natural laxtive that helps pass mecomin
colotrsum
how is bilirubin made
breakdown of HEME
lifespan of neonatal RBC
shorter than adults
what causes increase bilirubin production in NB
more RBC/ Hb made due to shorter lifespan?
what infants get polycythemia
diabetic mothers babies
when are bilirubin levels checked
24-72hrs after birth
how does jaundice move
down the body, head to down , in sclera
physiological jaundice appears when and resolves
- AFTER 24 HRS AGE
- without treamtent mostly
pathological jaundice (time)
within 24 hour of age
reasons for physiplogical jaundice
- high rbc mass, short lifepsan
- reduce abilty of liver to conjugate
-fewer bilirubin bindings sites - conugated changes in unconjugates in intestine
what number means hyperbilirubinemia
more than 340 in the first 28 days of life? or less
does bilirubin cross BBB
yes
kernicterus is
long term
- irreversible consequence of bilirubin toxciity
cant undo
signs and symtpms of encephalopathy
lethargy
hypotonia
irrtiabilty
seziures
coma
death
what can cause bilirubin to displace from albumin
cold tress or asphyixa
what race pop has higher risk of hyperbilurbinemia
asian and indigenous babies
what gender baby is more likely to get hyperbili
boy babies
how to check for jaundice
- press done on forehead (bony prominece) can see jaundice in between
darkskinned babies: sclera and mucos membrane - natural light
reducing risk of jaundice
-early bf
- feed frequent
- avoid glucose water (dont wanna take up space)
- meconim water
transcutaneous bilirubin screening
- checking bilirubin levels
- tale three readings and take avg
- first 72 hrs of life or earlier
- can do same time as metabolic screening
when are Tcb more accurate
before the start of phototherapy
lower levels??
checking for bilirubin if mom is rh-
direct antiglobunin test or Coombs test
first line of treatment of hyperbilirub
phototherapy
how often should infant with hyperbilrubin be weighed
every day
why is it important to assess skin turgor for baby in phototherapy
hydration status
can you put oily substance on baby on phototherapy
no
why are babies more prone to heat loss
bv closer to skin
large surface to body ratio
what is brown fat rich in
rich in blood supply
can babies make more brown fat once its gone
no
non shivering thermogenesis
- brown fat user
where does metabolic actvity increase during cold
liver and brain
evaporation
had bath, not dried right away, water evaporates and takes thier heat
conduction
on cool surface
convection
cool air flowing near them
radiation
near a window during winter time
when is non shivering thermogensis triggered
35-36 C
effects of cold stress
hypoglucemic
met acidosis
resp distress
used brownf ats
less activtyL hypotonia
peripheral vc
babies with sepsis
pale
hands and feet are cool
hypoglycemia numbers
less than 2.6
do healthy abbies need glucose screening
no
3rd day glucose number in NB
4-6mmol/L
what makes NB at risk for hypoglycemia
- moms with diabetes
gest hypertension - small of gest, large
preterm
cold stress
infection
any other stress
congential issues
hyperthermia
polycythemia
when to measure glucose for babies with risk factors for hypoglyecmiea
2 hrs after birth and every 3-6 afters
- intial check one breast feeding
clincal manisfestions of NB hypoglycemia
jittery
cyanosis
weakcry
high pitched cry
poor feeding
hypotonia
temp isntablity
resp dispress
apnea
seixures
when to discontuen bg checking
if stable for 24 hrs
at 2.6 or more mmol/L
really hypoglycemic babies
give IV dextrose
