L3: Neonatal Jaundice Flashcards
(138 cards)
1
Q
Bilirubin Metabolism
A
2
Q
Bilirubin Metabolism
- RES
A
Most of bilirubin (75%) is derived from the breakdown of RBCs
3
Q
Bilirubin Metabolism
- Plasma
A
Unconjugated bilirubin tightly bound to albumin → become Water insoluble
4
Q
Bilirubin Metabolism
- Liver
A
5
Q
Bilirubin Metabolism
- Intestine
A
6
Q
Why Jaundice is important in newborn babies?
A
- It is a common problem that may indicate underlying disease
- Unconjugated bilirubin is neurotoxic
7
Q
Etiology of Neonatal Jaundice
A
8
Q
Etiology of Neonatal Jaundice
- Unconjugated Hyperbilirubenemia
A
9
Q
Etiology of Neonatal Jaundice
- Conjugated Hyperbilirubenemia
A
10
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Increased hemolysis
A
11
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Corpuscular Hemolysis
A
12
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Extracorpuscular Hemolysis
A
13
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Immunological Hemolysis
A
14
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Infectious Hemolysis
A
15
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Traumatic Hemolysis
A
16
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Toxic Hemolysis
A
excessive Vit K administration’’
17
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Polycythemia
A
…
18
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Decreased Conjugation
A
Physiological jaundice
19
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Immature glucuronyl transferase enzyme
A
20
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Inhibited glucuronyl transferase enzyme
A
21
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Absent or decreased glucuronyl transferase enzyme
A
22
Q
Etiology of Neonatal Unconjugated Hyperbilirubinemia
- Inadequate or poor feeding intake
A
23
Q
Etiology of Neonatal Conjugated Hyperbilirubinemia
A
24
Q
Etiology of Neonatal Conjugated Hyperbilirubinemia
- Neonatal hepatitis
A
25
Etiology of **Neonatal Conjugated Hyperbilirubinemia**
- Biliary Obstruction
...
26
Etiology of **Neonatal Conjugated Hyperbilirubinemia**
- Increased entero-hepatic circulation
27
Incidence of **Physiological Jaundice**
The commonest cause of neonatal jaundice
28
Timing of **Physiological Jaundice**
29
Characters of **Physiological Jaundice**
30
Characters of **Physiological Jaundice**
- Onset
▪ After 24 hours (on 2nd
▪ Never in 1st day
31
Characters of **Physiological Jaundice**
- Peak
▪ By 4th-5th day in term.
▪ 7th day in preterm.
32
Characters of **Physiological Jaundice**
- Dissappearence
▪ By 7-10 days of life.
▪ Clinically not detectable after 14 days.
33
Characters of **Physiological Jaundice**
- Max Level
Doesn’t exceed 15 mg/dL
34
Characters of **Physiological Jaundice**
- General Condition
Good & kernicterus doesn’t occur
35
Mechanism of **Physiological Jaundice**
36
Mechanism of **Physiological Jaundice**
- Main Cause
Relative immaturity of glucuronyl transferase enzyme
37
Managment of **Physiological Jaundice**
38
Exaggerated Physiological Jaundice
39
Causes of **Exaggerated Physiological Jaundice**
40
Examples of Exaggerated Physiological Jaundice
- Breastfeeding jaundice ‘’ Breast milk deficiency jaundice’’
- Breast Milk Jaundice
41
Another Name of **Breastfeeding jaundice**
Breast milk deficiency jaundice
42
Incidence of **Breastfeeding jaundice**
13% of breast-fed infants
43
Etiology of **Breastfeeding jaundice**
- ↓↓ milk intake with dehydration → ↑↑ enterohepatic circulation.
- ↓↓ caloric intake by giving supplement of glucose water to breast fed jaundice
44
Characters of Breastfeeding jaundice
- Onset
- Peak
- Disappearence
- Bili Lvl
- General Condition
45
Dx of **Breastfeeding jaundice**
.....
46
Prevention & TTT of Breastfeeding jaundice
- Frequent breast-feeding day and night.
- Discourage 5% dextrose or water supplementation
47
Incidence of **Breast Milk Jaundice**
2% of breast-fed term infants ‘’Recurrence in 70% of future pregnancy’’
48
Etiology of **Breast Milk Jaundice**
49
Characters of Breast Milk Jaundice
- Onset
- Peak
- Disappear
- Bili LVL
- General Condition
50
Dx of Breast Milk Jaundice
51
Prevention & TTT of **Breast Milk Jaundice**
52
Compare between Physiological, Breast Feeding & Breast Milk in terms of:
- Incidence
- Characters
- Onset
- Peak
- Disappearence
- Bili LVL
- TTT
53
Onset of **Pathological Jaundice**
Appearing in the 1st day or after the 1st week.
54
Duration of **Pathological Jaundice**
Persisting after 14 days
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Bili LVL in **Pathological Jaundice**
56
General Condition in **Pathological Jaundice**
▪ Signs of underlying illness.
▪ Pallor, hepatomegaly & splenomegaly → signs of hemolytic anemia
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Stool & Urine in **Pathological Jaundice**
▪ Stool clay colored.
▪ Urine staining clothes yellow
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Familial Hx in **Pathological Jaundice**
Familial history of hemolytic disease
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Etiology of **Pathological Jaundice**
- Unconjugated hyper-bilirubine
- Conjugated hyper-bilirubinemia
60
Etiology of **Pathological Jaundice**
- Unconjugated Hyperbilirubinemia
As before
61
Etiology of **Pathological Jaundice**
- Conjugated Hyperbilirubinemia
As before
62
Etiology of **Pathological Jaundice**
- Conjugated Hyperbilirubinemia (Hepatocellular failure of transport or excretion (Neonatal hepatitis)
63
Etiology of **Pathological Jaundice**
- Conjugated Hyperbilirubinemia (Biliary obstruction)
64
Etiology of **Pathological Jaundice**
- Conjugated Hyperbilirubinemia (Increased enterohepatic circulation)
65
Rh Incompatibility & ABO Incompatability
- Incidence
66
Rh Incompatibility & ABO Incompatability
- Etiology
67
CP of **Rh Incompatibility & ABO Incompatability**
- First Baby
- Severity
- jaundice
- Pallor
- Liver & Spleen
- Hydrops Fetalis
68
Dx of **Rh Incompatibility & ABO Incompatability**
- Blood Group
- Hemolytic anemia
- Coomb's test
- HB
- Others?
69
Prevention of **Rh Incompatibility & ABO Incompatability**
70
TTT of **Rh Incompatibility & ABO Incompatability**
71
Prenatal TTT of **Rh Incompatibility**
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Prenatal TTT of **Rh Incompatibility**
- Serial anti D titer determination
- for evaluation of sensitization in Rh negative pregnant woman.
73
Prenatal TTT of **Rh Incompatibility**
- Evaluation of fetal well-being (if mother is
sensitized) by ....
- Repeated fetal ultrasound for hydrops fetalis
- Amniocentesis & cordocentesis.
74
Prenatal TTT of **Rh Incompatibility**
- Interference (if the titer is critically rising) either
by ......
- Premature induction of labor.
- Intrauterine exchange transfusion (with O -ve RBCs into fetal umbilical vein)
75
Postnatal TTT of **Rh Incompatability**
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Postnatal TTT of **Rh Incompatability**
- Exchange Transfusion
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Postnatal TTT of **Rh Incompatability**
- Indications of Exchange Transfusion
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Postnatal TTT of **Rh Incompatability**
- Phototherapy
Before and after exchange transfusion to prevent
further increase of Bilirubin
79
Postnatal TTT of **Rh Incompatability**
- IVIG
Yes
80
Pre-natal TTT of **ABO Incompatability**
No preventive measures except for instructions
especially to group O pregnant women.
81
Post natal TTT of **ABO Incompatability**
82
Early detection is crucial for early start of phototherapy since some cases may have high bilirubin level eventually → kernicterus
...
83
Compare between Rh Incompatability & ABO Compatability
84
Types of Crigler-Najjar syndrome
- Crigler-Najjar syndrome type I
- Crigler-Najjar syndrome type II
85
Compare between CN I & CN II in terms of:
- Inheritance
- UGT activity
- jaundice
- TTT
86
Incidence of **Gilbert's syndrome**
Most common inherited disorder of bilirubin glucuronidatio
87
Etiology of **Gilbert's syndrome**
- Mutation in the promoter region of the UGT1A1 gene → ↓↓ production of UGT
88
Dx of **Unconjugated Hyperbilirubinemia**
89
Dx of **Unconjugated Hyperbilirubinemia**
- Hx
90
Dx of **Unconjugated Hyperbilirubinemia**
- Ex
91
Dx of **Unconjugated Hyperbilirubinemia**
- INVx
92
Def of **Bilirubin Encephalopathy (Kernicterus)**
93
pathophysioology of **Bilirubin Encephalopathy (Kernicterus)**
94
**Bilirubin Encephalopathy (Kernicterus)**
- Factors determining brain damage
95
CP of **Bilirubin Encephalopathy (Kernicterus)**
96
CP of **Bilirubin Encephalopathy (Kernicterus)**
- Acute
97
CP of **Bilirubin Encephalopathy (Kernicterus)**
- Acute (1st Phase)
98
CP of **Bilirubin Encephalopathy (Kernicterus)**
- Acute (2nd Phase)
99
CP of **Bilirubin Encephalopathy (Kernicterus)**
- Acute (3rd Phase)
100
CP of **Bilirubin Encephalopathy (Kernicterus)**
- Chronic
101
TTT of **Uncojugated Hyperbilirubinemia**
102
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Def
Exposure of the skin to day light lamps with wavelength 425-475 nanometer.
103
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Mechanism
104
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Factors influencing efficiency of phototherapy
105
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Types
106
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Application of phototherapy ‘’precautions’’
107
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Indications
108
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Technique
Repeat S. bilirubin measurement
- 4–6 hours after initiating phototherapy.
- Then every 6–12 hours when the serum bilirubin level is stable or falling.
109
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- when to stop?
When S. bilirubin is 3 m g/ dl below the phototherapy threshold
‘‘12 – 13 m g/ dl’’
110
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- Follow up
Repeat serum bilirubin measurement 12–18 hours after stopping phototherapy for rebound of significant hyperbilirubinemia.
111
Phototherapy in TTT of **Uncojugated Hyperbilirubinemia**
- SE
112
Rule of **Home phototherapy**
1. Alternative to readmission to the hospital
2. Less disruptive to the family
113
Indications of Home phototherapy
114
Value of **Sunlight exposure**
Exposure to sunlight provides sufficient irradiance in the 425 to 475 nm band.
115
Rule of **Sunlight exposure**
Not recommended ---> to avoid sunburn
116
Exchange Transfusion in TTT of Hyperbiliruinemia
- Indications
117
Exchange Transfusion in TTT of Hyperbiliruinemia
- Aim
- Remove indirect bilirubin.
- Remove sensitized cells.
- Correct anemia.
118
Exchange Transfusion in TTT of Hyperbiliruinemia
- Amount
Double blood volume (2 X 85 X body weight in kg)
119
Exchange Transfusion in TTT of Hyperbiliruinemia
- Type of Blood
120
Exchange Transfusion in TTT of Hyperbiliruinemia
- Technique
Umbilical vein catheter Alternating pull & push of 10-20 ml blood.
121
Exchange Transfusion in TTT of Hyperbiliruinemia
- Complications
122
Exchange Transfusion in TTT of Hyperbiliruinemia
- To decrease the risk of GVHD, ......
use Irradiated blood products
123
Exchange Transfusion in TTT of Hyperbiliruinemia
- After exchange transfusion, .....
- Maintain continuous multiple phototherapies.
- Measure serum bilirubin level within 2 hours and manage accordingly.
124
Indications of ****IVIG****
When bilirubin level surpasses the exchange transfusion limit.
125
Aim of **IVIG**
- To ↓↓ the level of bilirubin in infants with isoimmune hemolytic disease.
126
Mechanism of **IVIG**
127
Dosage of **IVIG**
128
Def of **Conjugated Hyperbilirubinemia**
↑↑ level of direct or conjugated bilirubin > 20 % of total serum bilirubin.
129
Etiology of **Conjugated Hyperbilirubinemia**
Mentioned before (See causes of pathological jaundice)
130
Dx in **Conjugated Hyperbilirubinemia**
- Hx
131
Dx of **Conjugated Hyperbilirubinemia**
- Ex
132
Dx of **Conjugated Hyperbilirubinemia**
- INVx
133
**DDx of Jaundice**
134
**DDx of Jaundice**
- 1st 24 hours
135
**DDx of Jaundice**
- 24 hours - 72 hours
136
**DDx of Jaundice**
- 3rd - 5th day
137
**DDx of Jaundice**
- After 1st week
138
**DDx of Jaundice**
- More than 4 weeks
