Peds 8 Flashcards
What is the most serious problem that can result when a newborn infant has high levels of unconjugated bilirubin?
Kernicterus, neurologic impairment, brain damage, or encephalopathy
A healthy-appearing infant who develops jaundice, dark urine, and acholic (pale) stools between birth and 6 weeks of age
Dx and immediate management?
Biliary atresia
Refer to pediatric gastroenterologist or pediatric surgeon as soon as possible
Treatment of biliary atresia?
Kasai procedure (anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine).
Recommended supplement for exclusively breastfed infants younger than 6 months of age?
Vitamin D 400 IU daily
S/s: Subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery. The swelling does not extend across a suture line.
Dx?
Cephalohematoma
S/s: Edematous swelling over the presenting portion of the scalp of an infant and is commonly seen in babies born vaginally in vertex position. Because the scalp overlies the periosteum, this boggy swelling crosses suture lines.
Dx?
caput succedaneum
Which one(s) increases risk of hyperbilirubinemia?
A. Cephalohematoma
B. Caput succedaneum
C. Bruising
A. Cephalohematoma
C. Bruising
Because r/t breakdown/movement of erythrocytes
Meghan is a vigorous, 6-day-old, exclusively breastfed term infant of partial Greek descent with two days of jaundice and an otherwise normal physical exam. She has had no significant weight loss and is voiding and stooling normally. There is an ABO set-up (6 days old, female, term, breastfed, and of partial Greek descent).
What is the most likely dx and what do you next to narrow confirm it?
Breastfeeding jaundice
Order total serum bilirubin
6-day-old infant with breastfeeding jaundice TsB comes back in high-intermediate risk zone. What do you do next?
Continue breastfeeding and recheck total bilirubin level in 24 hours.
A 4-day-old infant presents for his first pediatric well-child visit. His birth history consists of an uncomplicated normal spontaneous vaginal delivery after 7 hours of uncomplicated labor (no vacuum or forceps assistance). The patient is the first child to a 30-year-old mother of Mediterranean descent. Mom is very concerned that her baby has started to look “yellow” since leaving the hospital. She has been breastfeeding every 2-3 hours and says that the baby latches on for 1-5 minutes for each feed. He has had few wet diapers, and mom is concerned he is not getting enough to eat. Which of the following would most aid in narrowing the differential diagnoses?
A. Blood smear B. Fractionated bilirubin C. Newborn screen results D. No further workup is needed, as this is likely physiologic jaundice E. WBC
B. Fractionated bilirubin
A concerned mother brings her 7-day-old infant to your office after noticing yellowing of his skin for two days. She has also noticed he has not been gaining weight since she brought him home from the hospital five days ago. Mother reports she is feeding the baby six times per day for 10 minutes each time. Mother admits her breasts often feel full and are not relieved by nursing. The baby was born full term by spontaneous vaginal delivery but has a hard time sucking with breastfeeding. Upon exam, he looks dehydrated and appears to have jaundice of the face and chest. He has also lost > 10% of his birth weight. What is the most likely cause of his jaundice?
A. Breastfeeding jaundice B. Breast-milk jaundice C. Crigler-Najjar syndrome D. Physiologic jaundice E. Sepsis
A. Breastfeeding jaundice
A 5-day-old infant presents with a chief complaint of jaundice. As you obtain a careful history, which of the following would NOT be a risk factor for neonatal jaundice?
A. Mediterranean origin
B. Mother is type O+ and baby is type B
C. Phenylketonuria
D. Poor breastfeeding during first few days of life
E. Prolonged labor with use of forceps during the delivery
C. Phenylketonuria
A 3-week-old infant is brought to his pediatrician with a chief complaint of light tan-colored stools and worsening jaundice. He is exclusively breastfed and has six to eight wet diapers per day. On exam, he appears to have scleral icterus and jaundice. Upon further workup, he is found to have an elevated direct bilirubin. What is his most likely diagnosis?
A. Biliary atresia B. Breastfeeding jaundice C. Caput succedaneum D. G6PD deficiency E. Physiologic jaundice
A. Biliary atresia
