class 10 newborn complications Flashcards
(53 cards)
What is jaundice?
elevated serum unconjugated bilirubin levels
What are the 2 types of jaundice?
physiologic
pathologic
which jaundice do MOST newborns experience?
physiologic jaundice
What causes increased unconjugated bilirubin levels?
RBC break down = unconjugated bilirubin
liver process it so = immature liver
Why is unbound bilirubin a bad thing?
it can leave the blood stream and go into tissues
can cross the blood brain barrier
what are the 5 reasons a newborn could have normal physiological jaundice?
- too many RBC at birth so they break down
- RBC don’t live as long - 60-90 days
- Newborn liver can’t make bilirubin water soluble in first few days of life
- not enough albumin to carry the bilirubin to the liver
- enterohepatic circulation is in overdrive so too much bilirubin is being absorbed - not filtered out well
What is the BEST method to help prevent jaundice?
Early
frequent
breast/chest feeding
what is a normal % of weight loss for newborns?
5-7% over first 3 days
regain within 10-14 days of life
what gestational age babies are at risk for jaundice?
35-38 weeks GA
How do we know if a newborn has neurotoxicity - acute bilirubin encephalopathy?
- lose startle reflex
- lethargic - not eating well
- high pitched cry
- irritable
- seizure
- coma
- death
what are the results of chronic bilirubin encephalopathy (kernicterus) ?
- long term brain damage
- hearing loss
- CP
- gaze abnormalities
What is the main difference between physiologic and pathologic jaundice ?
physiologic = AFTER 24 hours it appears - usually resolves without treatment in 2 weeks
- not due to underlying condition
pathologic = UNDER 24 hours it appears
- TBS increases more than 100 mcmol/L in 24 hours
TSB >256mcmol/L
- underlying condition
what is HDN (hemolytic disease of the newborn)?
erythoblastosis fetalis
- RBC broken down or destroyed tooo quickly
= anemia = increased bilirubin
What blood type is the newborn with risk for hemolytic disease (HDN)?
RH+ newborn
RH- birther
What are the 2 causes of HDN (hemolytic disease of newborn)?
- ABO incompatibility - blood/antibody issue in the newborn - coombs test (DAT) for antibodies
- Rh Isoimmunization - baby is Rh+ and mom is Rh- blood mixed and baby didn’t like it
How does WinRHO help the birther ?
it masks leftover fetal RBCs in maternal circulation so that 2nd fetus is protected regardless of Rh status
Which HDN is more severe, Rh Isoimmunization or ABO incompatibility?
Rh Isoimmunization
sometimes jaundice is neither pathological nor physiological. What is the other cause of jaundice?
Chest/breast feeding
When does chest/breast feeding jaundice occur and why?
(early)
days 2-5
insufficient feeding/stooling
(late)
days 5-10
good feeding/weight gain
compound in milk that inhibits the glucuronyl transferase so it can’t become water soluble and excreted
what do we do for early chest/breast jaundice?
suppliment feeding
support breast feeding better so baby gets more milk
As part of the newborn jaundice assessment what are 3 things nurses do as part of this assessment?
- routine inspection
- routine TcB - transutaneous bilirubin monitor (like a forehead thermometer)
- TSB - total serum bilirubin - IF
According to WRHA policy how often do newborns get screened for jaundice and when?
between 24-30 hours
q morning until discharge
Which is the first test that is done for jaundice, TcB or TSB?
TcB - think little c = less concerned
Where is the prefered place for TcB reading?
infant’s forehead
