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Peds: Neonatal Jaundice
Peds: Neonatal Jaundice Exam 2
46
Anatomy
Graduate
03/07/2012

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Term
1 gram of hemoglobin =
Definition
34 gm billirubin
Term
aHemoglobin gets broken down into ___ and then into __ in RES. In circulation, bilirubin is ___ and bound to __. It is transferred to __ and __ by __ __. It is then excreted via the __ __ into the __ __.
Definition
- biliverdin
- bilirubin
- unconjugated and bound to albumin
- hepatocytes and conjugated by glucuronyl transferase
- bile duct into the small intestine
Term
Gut flora metabolize __ bilirubin into __ that are excreted in the stools.
Definition
- conjugated bilirubin into stercobilins that are excreted in the stools
Term
With limited gut flora and slow motility, bilirubin is converted back to the ___ form and reabsorbed.
Definition
unconjated
Term
Newborns have higher levels of bilirubin than adults b/c?
Definition
ILIDS:
- Immature liver (decreased glucuronyl transferase)
- Large RBC load (so higher Hct 60-65)
- Increased enterohepatic circulation
- Degradation of extra hematopoietic tissue
- Shortened RBC lifespan (90 instead of 120)
Term
Normal total serum bilirubin:
Definition
< 1.5-2.5
Term
Indirect hyperbilirubinemia:
Definition
total bilirubin > 2.5 with direct < 15%
Term
Direct hyperbilirubinemia:
Definition
direct greater than 2.0
Term
__ hyperbilirubinema is lipid soluble and may enter brain.
Definition
Indirect
Term
___ hyperbilirubinemia is water soluble. Suspect this if there is bilirubin in the urine.
Definition
Direct
Term
Bilirubin in the urine, suspect ___ hyperbilirubinemia.
Definition
direct
Term
2 types of indirect hyperbilirubinemia:
Definition
1. Physiologic Jaundice (MC jaundice in newborns)
2. Pathologic Jaundice
Term
Indirect Physiologic Jaundice:
Definition
FORP
- Full term infant < or equal to 15
- Occurs >24 hours after birth
- Resolves by 1 week in full term infants or 2 weeks in preterm infants
- Peaks at 3 -5 days
Term
Pathologic jaundice:
Definition
BMCVT
- Bilirubin increase > 5 mg/dl/day or > 0.5 mg/dl/hr
- May appear in first 24 hours
- Conjuated bili > or equal to 2.0
- Visible jaundice on DOL 1 or after 2 weeks
- Total bilirubin > 5 on DOL 1, or total bilirubin > 15 after DOL 1
Term
2 main causes of pathologic indirect hyperbili:
Definition
- Increased production
- Decreased clearance
Term
causes of increased production leading to pathologic indirect hyperbilirubinemia:
Definition
- Antibody mediated hemolysis (Coomb's test positive)
- Non-antibody mediated hemolysis (Coombs test negative)
- Extravascular hemolysis
- Increased enterohepatic circulation
Term
When is rhogam given to Rh- mom:
Definition
- 28 weeks
- delivery
- any invasive procedure where blood transfer occurs
Term
what is Rh isoimmunization:
Definition
mom is RH-, baby RH+, so mom's blood forms antibodies to baby
Term
complications of Rh isoimmunization:
Definition
- hydrops in utero
- severe anemia
- hyperbilirubinemia
Term
Examples of antibody mediated hemolysis (increased production) resulting in pathologic indirect hyperbilirubinemia:
Definition
- ABO mismatch
- Rh isoimmunization
Term
Examples of non-antibody mediated hemolysis leading to pathologic indirect hyperbilirubinemia:
Definition
- Structural (MC Spherocytosis)
- Enzyme deficiencies (MC G6PD deficiency)
Term
With spherocytosis RBCs collect in the __ and cause __. These pts tend to have a family history of __, __, and __.
Definition
- spleen
- splenomegaly
- gallstones
- anemia
- jaundice
Term
G6PD deficiency is __ linked and occurs in __ of __, __, or __ descent.
Definition
- x-linked
- males
- African
- Mediterrranean
- Asian
Term
Non-hemolytic causes of increased bilirubin production:
Definition
- Hematoma or bruising (cephalohematoma)
- Hemorrhage (IVH or abdominal)
- Excess RBC production (polycythemia, RBC > 60)
Term
Increased enterohepatic circulation can cause pathologic indirect hyperbilirubinemia, causes of this include:
Definition
- decreased motility
- decreased stooling (meconium plug, bowel obstruction)
Term
Causes of decreased clearance leading to pathologic indirect hyperbilirubinemia:
Definition
- Prematurity: decreased conjugation in liver
- Glucuronyl transferase deficiency: Type 1 Criler Najaar Syndrome (recessive, poor prognosis) Type 2 dominant good prognosis
- Gilbert's Syndrome- dominant, benign, get ill and become jaundiced in older age, scleral icterus in AA children, decreassed glucuronyl transferase
Term
Breast Milk Jaundice:
Definition
- Normal weight gain
- Prolonged unconjugated hyperbilirubinemia, peaks at 10-15 days
- Unknown factor in breast milk prevents conjugation of bilirubin
- Increased enterohepatic circulation
- Interrupt breast feeding for 24 hours, levels drop rapidly, resume breast feeding after 24-48 hours
Term
Is breast milk jaundice common?
Definition
NO
Term
Breast Feeding Jaundice:
Definition
"lack of feeding"
- Decreased intake <10min/feeding or less than 8 feedings/day
- Decreased stooling < 4/day
- Decreased UOP < 6/day
- Weight loss > 8-10%
- Increased enterohepatic circulation
- Failure to establish milk supply
- Supplement with formula and/or increase BF to every 2 hours
Term
Important hx questions for jaundice newborn?
Definition
BAMMCC
- Birth trauma
- Antibody titers
- Maternal DM or infections
- Maternal/infant blood type
- Cord blood hemoglobin
- Coombs test
Term
PE of jaundice baby:
Definition
- bruising/hematoma?
- HSM (spleen palpable in 30% of nml newborns)
- Plethora
Term
Lab studies to order on jaundice newborn:
Definition
- CBC
- Peripheral smear (check for hemolysis)
- Reticulocyte count (check for hemolysis)
- IBT and Coombs test (even if mom is not O or Rh- b/c can find anti-Duffy or anti- Kell antibodies
- Total bilirubin
- Fractionated bilirubin
Term
Kernicterus is staining of the __ __ leading to ___. List the acute sympotoms of this.
Definition
- basal ganglia
- encephalopathy
Acute symptoms:
- lethargy
- decreased tone
- high pitched cry
- poor feeding
- vomiting
- hypertonic seizures
- opisthotonus
- scissoring of feet
Term
Late sequellae of kernicterus:
Definition
- neuro deficits
- mental retardation
- deafness
- choreoatheltoid cerebral palsy
Term
risk of kernicterus in term infants:
Definition
- small if without hemolysis, even at bilirubin of 25
Term
3 main aspects of management of indirect hyperbilirubinemia:
Definition
1. Hydration with supplmental feeding
2. Glycerin suppository to increase stooling
3. Phototherapy
Term
when to start phototherapy:
Definition
full term infant bili 15-18
Term
In a hemolytic full term infant, phototherapy should be used to keep bili less than __.
Definition
20
Term
5 treatment steps for management of jaundice newborn:
Definition
1. hydration
2. glycerin suppository to increase stooling
3. Phototherapy
4. IV albumin to increase binding
5. Exchange transfusion (only severe cases)
Term
Risks with exchange transfusion:
Definition
- Bleeding
- Hypocalcemia
- Infection
- Death
Term
Difficulty feeding
Excess weight loss
Jaundice at DOL 3-5
Definition
Breast Feeding Jaundice
Term
elevated retic count indicates:
Definition
hemolysis
Term
G6PD races:
Definition
AMA
- AA
- Mediterranean
- Asian
Term
AA, Meditteranean, Asian, male, sibling affected jaundice;
Definition
G6PD deficiency
Term
spherocytosis is autosomal __.
Definition
dominant
Term
FHx anemia and splenectomy:
Definition
spherocytosis
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