Case 8 - 6 day old with jaundice Flashcards
(30 cards)
Which one has potential serious consequences: unconjugated or conjugated hyperbilirubinemia?
unconjugated because it can cross the BBB and cause kernicterus
What areas of the brain are affected by kernicterus?
basal ganglia and cranial nerve nuclei
What are some of the signs and symptoms of kernicterus?
babies that lose the suck reflex, become lethargic, develop hyperirritability and seizures
can ultimately die
Infants who survive kernicterus can develop what?
opisthotonus rigidity oculomotor paralysis tremors hearing loss ataxia
What was the most common cause of kernicterus in the past?
hemolysis and subsequent unconjugated hyperbilirubinemia that was caused by Rh incompatibility before rhogam
75% of the bilirubin produced in health newborns comes from where?
physiological breakdown or RBCs
What enzyme conjugates bilirubine iwht glucuronide?
uridine diphosphate glucuronyl transferase (UDPGT)
Why does the conjugated bile in a baby’s GI tract get hydrolyzed back to its unconjugated form and then reabsorbed into the blood stream to cause problems?
babies lack the GI flora to metabolize bile, which allows the glucuronidase present in meconium to hydrolyze it back tot he unconjugated form
Jaundice that is caused by this enterohepatic circulation issue is caused what?
physiologic jaundice
Physiologic jaundice is usually with a total bili less than ___ in full-term infants who are otherwise healthy. It’s benign and self-limited. When does it present?
<15
presents by the second or third day of life, peakin gon days 3 or 4
What is breastfeeding jaundice?
it’s when there’s a relatively low milk supply (so happens early in the first week of life), resulting in limited enteral intake
the low intake decreases GI motility, which promotes retention of the meconium that has the glucuronidase to deconjugate the bili
(so difficult to distinguish from physiologic jaundice and probably overlaps)
What is breast-milk jaundice?
the glucuronidase present in breast milk deconjugates the bilirubin in the GI tract and is reabsorbed
When does breast-milk jaundice present?
Days 4-7
What lab should you run to test for hemolysis as a cause of jaundice?
Coombs test
What are some non-hemolytic RBC breakdown causes that can lead to jaundice?
extensive bruising from birth trauma
large cephalohematoma or other hemorrhage
polycythemia at birth
swallowed blood (from mom) during delivery
Which ethnicities have more jaundice?
asians more so than caucasians more so than blacks
What is a typical breastfeeding pattern for a new baby?
8-12 times/day; about 10-15 minutes at each breast
True or false: infants younger than 12 months should not be fed unmodified cow’s milk.
true
How often should a newborn pee?
3-4 times during days 3-6
6-8 times after day 6
How many stools do most newborns have in a day?
3-4
Stool that gradually loses color and becomes “acholic” could be a sign of what? (especially when accompanied by jaundice and dark urine)
biliary atresia
What is the treatment for biliary atresia?
if diagnosed early, can be treated surgically with the Kasai procedure (anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain direcctly into the intestine)
When should you get imaging (and what type) of the hip in all female infants born via breech delivery?
ultrasound at 4-6 weeks or hip/pelvis radiograph at 4 months
Hypothyroidism that is not detected on the newborn screen can cause what signs and symptoms?
prolonged jaundice lethargy large fontanelles macroglossia umbilical hernia constipation abdominal distention severe developmental delay
