newborn complications Flashcards
apgar score: definition
reflects immediate adjustment to extrauterine lifeA ctivityP ulseG rimaceA ppearanceR espirations
apgar scoring levels (3)
0-3: severe distress4-6: moderate difficulty7-10: adjusting to extrauterine life without difficulty
hyperbilirubinemia
excessive level of accumulated bilirubin in blood
bilirubin
breakdown product of hemoglobin secondary to red blood cell destruction
unconjugated bilirubin
(indirect) insoluble, usually bound to albumin in plasma- highly toxic to neurons
conjugated bilirubin
(direct) soluble, usually excreted/eliminated
free bilirubin
the only shit dat can cross the blood brain barrier, yo!
jaundice/icterus
yellow discoloration of skin, sclera, nails
jaundice observable at what bilirubin level?
> 5 mg/dL
acute bilirubin encephalopathy
acute manifestations of bilirubin toxicity that occur during the first weeks after birthcan lead to eventual intellectual disability, cerebral palsy, ADD/ADHD
bilirubin encephalopathy: s/s
CNS depression OR excitement
kernicterus
yellow staining of brain cells occuring when serum concentration of bilirubin reaches a toxic leveldiagnosis post-mortem = true kernicterus
physiologic jaundice
transitory jaundice that affects some infants for the first few days after birth, results from hyperbilirubinemia
hyperbilirubinemia causes (7)
- physiologic hyperbilirubinemia- breastfeeding (the milk!)- genetic predisposition: native american, asian- birth injury- disturbed capacity of liver to secrete conjugated bilirubin- disease states (congenital hypothyroidism, G6PD)- excessive production of bilirubin (hemolytic disease)
physiologic jaundice
- appears on day 2-3*- not associated with pathophysiologic process- mild, usually self-limited
pathologic jaundice
- appears within the first 24 hours- significant for sepsis, hemolytic disease of the newborn
breastfeeding jaundice: early
- day 2-4caused by insufficient production or intake of breast milkDON’T STOP BREASTFEEDING
breastfeeding jaundice: late
- day 4-7characterized by indirect hyperbilirubinemia in a breastfed newborn that persists longer than physiologic jaundice and has no other identifiable cause– can persist for 3-13 weeks– rarely causes kernicterus in healthy, full-termDON’T STOP BREASTFEEDING