Pediatric Jaundice Flashcards
If a patient has Conjugated hyperbilirubinemia, what should you suspect the problem is associated with?
Liver/biliary tree
If a patient has Unconjugated hyperbilirubinemia that is NOT bound to Albumin, what should you be worried will occur?
- Cross BBB
- deposit in basal ganglia and brainstem
= Kernicterus (permanent neuro dysfunction)
Direct Coombs test
Look for antibodies directly on RBCs
When is the Direct Coombs test important?
ABO incompatibility in newborns when hemolysis is suspected
Indirect Coombs test
Look for antibodies in SERUM that could bind RBCs
Why is the passage of stool important for bilirubin issues?
Excretes excess bilirubin
If stool remains in the gut, bilirubin is likely to get?
Reabsorbed back into blood stream
Babies most at risk for hyperbilirubinemia are born to moms that are?
Type O
OR
Rh (-)
Babies most at risk for hyperbilirubinemia are born to moms that are?
Type O
OR
Rh (-)
Unconjugated hyperbilirubinemia has many possible etiologies. List general mechanisms that can be impaired.
- Increased bilirubin production
- Decreased hepatic uptake and conjugation
- Increased enterohepatic circulation
Unconjugated hyperbilirubinemia has many possible etiologies. List general mechanisms that can be impaired.
- Increased bilirubin production
- Decreased hepatic uptake and conjugation
- Increased enterohepatic circulation
What 3 things are associated with Unconjugated hyperbilirubinemia due to impaired conjugation?
Crigler - Najjar
Gilbert Syndrome
LOW UGT1A1
Crigler Najjar type 1
ABSENT UDPGT
Crigler Najjar type 1 is at an increased risk for?
Kernicterus
Crigler Najjar type 2
Partial activity of UDPGT
Crigler Najjar type 1 or 2 - severe/mild jaundice?
Type 1 = severe
Type 2 = mild
What is the likely cause of Conjugated Hyperbilirubinemia in a child?
Biliary atresia
What is the likely cause of Conjugated Hyperbiliirubinemia in a child?
Biliary atresia
3 signs of Biliary atresia?
- Conjugated hyperbilirubinemia (jaundice)
- Hepatomegaly
- Acholic stools
3 signs of Biliary atresia?
- Conjugated hyperbilirubinemia (jaundice)
- Hepatomegaly
- Acholic stools
Phase 1 (1-2 days) of bilirubin toxicity
Jaundice, poor suck/tone, seizing and high pitched cry
Phase 2 (3-5 days) of bilirubin toxicity
Hypertonia of muscles, arching (opisthotonos), retrocollis
Phase 3 (week 1 and beyond) of bilirubin toxicity?
Hypertonia
Breast feeding jaundice is due to?
Combo of LOW mother’s milk and baby not knowing how to suck
Breast feeding jaundice is made worse by?
Dehydration and increased enterohepatic circulation in baby
Breast milk jaundice is due to?
Factor in breast milk that (-) bilirubin conjugation
Breast milk jaundice lasts about?
3-6 weeks
Both breast feeding and breast milk jaundice will?
Resolve - nurse through it
What does Phototherapy do?
Isomerizes unconjugated bilirubin to make it water soluble so the body can excrete it without needing liver
What does Phototherapy do?
Isomerizes unconjugated bilirubin to make it water soluble so the body can excrete it without needing liver
