EXAM #3: NEONATAL JAUNDICE Flashcards Preview

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Flashcards in EXAM #3: NEONATAL JAUNDICE Deck (27)
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1
Q
What is the definition of direct hyperbilirubinemia?
A
1) Serum conjugated/direct greater than 2 mg/dL
2) Serum conjugated/ direct GREATER THAN 20% OF TOTAL
2
Q
What does the bilirubin level need to be in the newborn to develop jaudice?
A
Greater than 5 mg/dL
3
Q
Where do you look if you're concerned about cyanosis?
A
Inside the mouth
4
Q
List some of the risk factors for jaundice in the newborn.
A
- Male
- Vacuum/ forceps
- Maternal fever/ GBS
- Maternal DM
- Maternal type O
- Maternal Rh neg
- Siblings with jaundice
- Excessive bruising
- Asian
- Breastfeeding
- PREMATURITY
5
Q
When does normal jaundice occur?
A
2nd to 5th day of life


*Note that Day 1 jaundice is NOT normal and IS concerning*
6
Q
Why is unconjugated hyperbilirubinemia concerning?
A
Bilirubin Encephalopathy/Kernicterus

****Accumulation of UCB in the basal ganglia*****
7
Q
What is the basis of physiologic jaundice?
A
- Increased RBCs
- Immature liver/ decreased UGT

*****UCB gets "stored" in skin and blood as liver catches up******
8
Q
What is the RBC lifespan in the newborn?
A
80 days
9
Q
What labs rule out PHYSIOLOGIC jaundice?
A
1) UCB greater than 13 in term infant
2) UCB greater than 15 in preterm
3) Increasing more than 5mg/dL in 24 hours

*Jaundice in first 24 hours or life*
10
Q
What are some signs of non-physiologic jaundice?
A
- Pallor or Plethora
- Petechia/ bruising
- Blueberry muffin lesion
- Cataracts
- Goiter
- HSM
- Abnormal tone
- Abdominal mass
11
Q
What is breastfeeding jaundice?
A
- Mom not making much milk
- Slight under-nutrition leads to jaundice
12
Q
What should women be recommended to do when breast-feeding?
A
Frequent feedings
13
Q
What is the most common cause of hemolytic disease of the newborn?
A
ABO incompatibility

*Hemolytic anemia increased UCB to liver that the liver can't handle*
14
Q
How is ABO incompatibility tested for?
A
Direct Coombs Test
15
Q
In Rh incompatibility, what does the mother need to be? Baby?
A
Rh- and baby Rh+ (from Dad)

****Note that b/c of immunologic memory, Rh incompatibility leads to worsening of disease****
16
Q
What is Breast Milk Jaundice?
A
Factor/ long chain fatty acid from breast milk competes with UCB binding to albumin and leads to hyperbilirubinemia
17
Q
When is Breast Milk Jaundice seen?
A
- Second week of life
- Breastfeeding well
18
Q
What do you do for Breast Milk Jaundice?
A
1) Typically, nothing
2) If high anxiety parent, formula feed for 2 days and then switch back
19
Q
What drug can be given to treat Crigler-Najar Type II?
A
Phenobarbital--increases UGT activity
20
Q
How do we assess for jaundice?
A
1) Visual--ballpark
2) Bilimeter (placed on skin)
3) Serum bilirubin (heel stick or cord blood)
21
Q
What are the nomogram risk zones based on?
A
Levels of bilirubin and HOURS of age
22
Q
When in the nomogram do you need to follow-up early?
A
1) High risk= 24 hours
2) Low to high--intermediate= 2-3 days
23
Q
How do you know when to start phototherapy?
A
Phototherapy nomogram
24
Q
What is phototherapy?
A
Irradiance with blue-green/ 430-490nm light

****Makes the UCB more water-soluble*****
25
Q
What are the risks of Phototherapy?
A
1) Retinal degeneration (cover eyes)
2) Increased insensible fluid loss
3) Bronze Baby Syndrome
4) Congenital Erythropoietic Porphyria
26
Q
What causes Bronze Baby Syndrome?
A
Treatment of CB with phototherapy
27
Q
What do you do if phototherapy is failing to control a rising bilirubin?
A
Exchange Transfusion (nomogram)