Neonatal Jaundice

Question 1

Define Direct Hyperbilirubinemia

Answer 1

Conjugated bilirubin is > 3 mg/dL

Question 2

MCCs of Direct Hyperbilirubinemia?

Answer 2

Biliary Atresia, Idiopathic Neonatal Hepatitis

Question 3

Define Indirect Hyperbilirubinemia

Answer 3

Unconjugated serum bilirubin is > 10 mg/dL

Question 4

What is the MCC of neonatal jaundice?

Answer 4

unconjugated hyperbilirubinemia

Question 5

What are some causes of Indirect (unconjugated) hyperbilirubinemia?

Answer 5

high bili load, defective uptake and conjugation, impaired excretion into bile

Question 6

What is the time frame for Physiologic Hyperbilirubinemia?

Answer 6

AFTER the first 24 hours
Peaks at 3 days
Resolves over 2 weeks

Question 7

Define Kernicterus

Answer 7

bilirubin neurotoxicity (deposition in basal ganglia)

Question 8

Some consequences of kernicterus?

Answer 8

neurologic deficits, hearing loss, encephalopathy, death

Question 9

How to prevent kernicterus?

Answer 9

Phototherapy (blue-green light converts bill in skin to isomers that are excreted w/out conjugation)

Question 10

At what level should phototherapy be started?

Answer 10

12-20 mg/dL

if > 20 mg/dL, consider exchange transfusion

Question 11

How does jaundice progress in neonates?

Answer 11

From head to toe (head/ neck @ 4-8, upper trunk @ 5-12, lower trunk/ thighs @ 8-16, arms/ legs @ 11-18, palms/ soles @ >15)