OnlineMedEd: Pediatrics - "Neonatal Jaundice"

Question 1

Elevated conjugated/direct bilirubin in adults is a sign of pancreatic cancer or gallstones. In kids, it is a sign of ______________.

Answer 1

biliary atresia, sepsis, or metabolic derangements

Question 2

Why is direct bilirubin the “good one” to have elevated (if you had to have one elevated)?

Answer 2

Direct bilirubin is charged and cannot cross the BBB, thus can’t cause kernicterus.

Question 3

The ___________ form of bilirubin causes urine to be dark.

Answer 3

direct

Question 4

Explain the typical presentation of physiologic jaundice.

Answer 4

• Rises after 72 hours
• Resolves in one week (two for preemies)
• Is unconjugated bilirubin
• Rises less than 5 points per day

Question 5

Explain the typical presentation of pathologic jaundice.

Answer 5

• Rises prior to 24 hours
• Takes longer than a week to resolve (longer than 2 for preemies)
• Is conjugated/direct bilirubin
• Rises faster than 5 points per day

Question 6

How do you decide whether to use lights or transfusion in treating unconjugated hyperbilirubinemia?

Answer 6

There is a nomogram that accounts for the baby’s age and other factors in determining the cutoff.

Question 7

How should you work up jaundice in an infant?

Answer 7

• Determine whether it is conjugated or unconjugated.
• For conjugated bilirubinemia, look for biliary atresia, sepsis, or metabolic errors.
• For unconjugated bilirubinemia, look for hemolysis (using a Coombs test) or hemorrhage (Hgb).

Question 8

Hematomas can also cause ____________ bilirubinemia.

Answer 8

unconjugated

Look for the cephalohematoma.

Question 9

Compare and contrast the two types of eating-related jaundice.

Answer 9

•Breast feeding:

• Caused by decreased quantity of feeds, which leads to hypomotility of the bowels and thus backup of unconjugated bilirubin.
• Usually presents within the first week.
• Treatable with increased feeds

•Breast milk:

• Caused by enzymes in breast milk that inhibit conjugation (thus is an unconjugated hyperbilirubinemia)
• Presents after the first week
• Treatable with formula feeds