Pediatric Jaundice

Question 1

If a patient has Conjugated hyperbilirubinemia, what should you suspect the problem is associated with?

Answer 1

Liver/biliary tree

Question 2

If a patient has Unconjugated hyperbilirubinemia that is NOT bound to Albumin, what should you be worried will occur?

Answer 2

• Cross BBB
• deposit in basal ganglia and brainstem
  = Kernicterus (permanent neuro dysfunction)

Question 3

Direct Coombs test

Answer 3

Look for antibodies directly on RBCs

Question 4

When is the Direct Coombs test important?

Answer 4

ABO incompatibility in newborns when hemolysis is suspected

Question 5

Indirect Coombs test

Answer 5

Look for antibodies in SERUM that could bind RBCs

Question 6

Why is the passage of stool important for bilirubin issues?

Answer 6

Excretes excess bilirubin

Question 7

If stool remains in the gut, bilirubin is likely to get?

Answer 7

Reabsorbed back into blood stream

Question 8

Babies most at risk for hyperbilirubinemia are born to moms that are?

Answer 8

Type O
OR
Rh (-)

Question 9

Babies most at risk for hyperbilirubinemia are born to moms that are?

Answer 9

Type O
OR
Rh (-)

Question 10

Unconjugated hyperbilirubinemia has many possible etiologies. List general mechanisms that can be impaired.

Answer 10

• Increased bilirubin production
• Decreased hepatic uptake and conjugation
• Increased enterohepatic circulation

Question 11

Unconjugated hyperbilirubinemia has many possible etiologies. List general mechanisms that can be impaired.

Answer 11

• Increased bilirubin production
• Decreased hepatic uptake and conjugation
• Increased enterohepatic circulation

Question 12

What 3 things are associated with Unconjugated hyperbilirubinemia due to impaired conjugation?

Answer 12

Crigler - Najjar
Gilbert Syndrome
LOW UGT1A1

Question 13

Crigler Najjar type 1

Answer 13

ABSENT UDPGT

Question 14

Crigler Najjar type 1 is at an increased risk for?

Answer 14

Kernicterus

Question 15

Crigler Najjar type 2

Answer 15

Partial activity of UDPGT

Question 16

Crigler Najjar type 1 or 2 - severe/mild jaundice?

Answer 16

Type 1 = severe

Type 2 = mild

Question 17

What is the likely cause of Conjugated Hyperbilirubinemia in a child?

Answer 17

Biliary atresia

Question 18

What is the likely cause of Conjugated Hyperbiliirubinemia in a child?

Answer 18

Biliary atresia

Question 19

3 signs of Biliary atresia?

Answer 19

• Conjugated hyperbilirubinemia (jaundice)
• Hepatomegaly
• Acholic stools

Question 20

3 signs of Biliary atresia?

Answer 20

• Conjugated hyperbilirubinemia (jaundice)
• Hepatomegaly
• Acholic stools

Question 21

Phase 1 (1-2 days) of bilirubin toxicity

Answer 21

Jaundice, poor suck/tone, seizing and high pitched cry

Question 22

Phase 2 (3-5 days) of bilirubin toxicity

Answer 22

Hypertonia of muscles, arching (opisthotonos), retrocollis

Question 23

Phase 3 (week 1 and beyond) of bilirubin toxicity?

Answer 23

Hypertonia

Question 24

Breast feeding jaundice is due to?

Answer 24

Combo of LOW mother’s milk and baby not knowing how to suck

Question 25

Breast feeding jaundice is made worse by?

Answer 25

Dehydration and increased enterohepatic circulation in baby

Question 26

Breast milk jaundice is due to?

Answer 26

Factor in breast milk that (-) bilirubin conjugation

Question 27

Breast milk jaundice lasts about?

Answer 27

3-6 weeks

Question 28

Both breast feeding and breast milk jaundice will?

Answer 28

Resolve - nurse through it

Question 29

What does Phototherapy do?

Answer 29

Isomerizes unconjugated bilirubin to make it water soluble so the body can excrete it without needing liver

Question 30

What does Phototherapy do?

Answer 30

Isomerizes unconjugated bilirubin to make it water soluble so the body can excrete it without needing liver