week 8 - newborn complications Flashcards
what is jaundice?
The clinical manifestation of elevated serum unconjugated bilirubin levels
what are the two types of jaundice?
physiologic vs. pathologic
what is physiologic jaundice?
“Physiological or nonpathological jaundice. APPEARS AFTER 24 HOURS AGE. and usually resolves without treatment”
Not due to an underlying condition
60% of term newborns & 80% of preterm newborns experience physiologic jaundice
what are potential outcomes of jaundice?
neurotoxicity - acute encephalopathy and or chronic encephalopathy
when would we teaqch families that jaundice might peak?
before about 5 days, at which point it plateaus
warning signs for jaundice to teach families:
decreased LOC, decreasing urine/stool, yellow
teach parents to do THIS to prevent jaundice?
more feeding! (results in more pooping to remove bilirubin)
risk factors for jaundice: (there are lots, try to name a few)
-preemie
-exclusive BF - not well established
-sibling with neonatal jaundice
-visible bruising
-cephalohematoma
-DAT or other hemolytic disease
-east asian background
-low apgar
-acidosis
-albumin <30g/L
-sepsis
-temp instability
-lethargy/poor feeding
what would acute neurotoxicity look like?
loss of startle reflex, poor feeding, lethargy, poor muslce tone, high pitched cry, irritability, seizures
treatment for jaundice with levels above threshold:
phototherapy
what is pathologic jaundice?
pathologic in origin or too severe. ALWAYS CONSIDERED PATHO IF PRESENTS BEFORE 24 HOURS.
what TBS level is considered jaundice?
> 256mcmol/L or increased to more than 100 in 24 hrs
what is Hemolytic disease of the newborn (HDN)?
What is it?
“Hemolytic disease of the newborn (HDN), also called erythroblastosis fetalis, is a condition in which red blood cells (RBC) are broken down or destroyed.”
Results into:
RBCs are destroyed quickly
Anemia
Higher rates of bilirubin production and subsequent jaundice
when is jaundice r/t breastfeeding considered “early”? what cacuses this?
days 2-5, usually d/t poor feeding/latch
when would we need to send a serum for assessing jaundice instead of TcB?
if bb is very bruised/discolored and can’t use the sternum, or if doesn’t match clinical picture, or if its before 24 hrs and they scored on the graph as higher risk
when is weigt loss concerning?
if losing >7%
when do we get concerned with stools and voids?
<3 stools/day by day 4, <4-6/voids/day by day r4
true or false: we use TcB to test bilirubin levels before and while on phototherapy
false. we use TSB once phototherapy is initiated
how much of the skin do we want exposed during phototherapy?
around 80%
last line of defence for treatment when phototherapy isn’t working
exchange transfusion
three indications for exchange transfusion
-phototherapy inadequate
-HDN
-acute bili encephalopathy signs
when conducting an assessment on a 35w gest. newborn, a heart murmur is heard. why?
because they have a patent ductus arteriosus
what do we do for a baby at risk of hypoglycemia after birht?
get bb to feed right away
what’s the protocol for checking BG for an IDM immediately after birht?
put bb skin to skin, feed them asap, and check BG 2 hours after birth, after first feed
