Pediatric Jaundice - Newman Flashcards Preview

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Flashcards in Pediatric Jaundice - Newman Deck (37)
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1

what is heme broken down into?

biliverdin and CO

2

what is biliverdin reduced to?

bilirubin

3

how do you get free unconjugated bilirubin?

albumin-binding sites are saturated, or unconjugated bilirubin is displaced from albumin by medicine

4

is unconjugated bilirubin lipid soluble?

yes, so it can cross the BBB

5

high hematocrit and RBC volume
- RBC with shorter life span
- inadequate conjugation of bilirubin by the liver due to immaturity of hepatic glucuronosyltransferase

newborns
- lots of unconjugated bilirubin present in their blood!

6

what is the most common type of bilirubin involved in neonatal hyperbilirubinemia

UNconjugated
- a result of hemolysis of RBC's

7

levels of what, increase rapidly in the first few weeks after birth?

UGT1A1
- initially the level is very low, overwhelming the amount of unconjugated bilirubin presented in the liver

8

what enzyme is located in the intestine, and deconjugates bilirubin (making it water soluble), allowing it to be reabsorbed from the gut into the blood?

beta-glucuronidase
- the rest is excreted in the stool

9

visible jaundice early in life usually means that the transcutaneous serum bilirubin (TSB) is at what level?

5 mg/dL

10

what causes jaundice?

hyperbilirubinemia

11

caused by dehydration and decreased excretion of bilirubin in the stool (more supply related)

breast FEEDING jaundice

12

due to the presence of bilirubin deconjugating enzymes in milk

breast MILK jaundice

13

conjugated hyperbilirubinemia is always what?

pathologic!

14

what causes unconjugated hyperbilirubinemia?

- increased bilirubin production: erythrocyte-enzyme def, ABO incompatibility, RBC structural defects, *G6PH def*
- hepatic uptake def
- impaired conjugated: Gilbert synd, Crigler-Najjar type 1, severe UGT1A1 def

15

all moms that are type O blood, or Rh (D) neg must have what test done?

a direct coombs test
- tests for autoimmune hemolytic anemia (erythroblastosus fetalis)

also check the infant's cord blood

16

what causes conjugated hyperbilirubinemia?

- UTI or sepsis
- **biliary atresia/cholestasis*
- hypothyroidism
- galactosemia

17

first 1-2 days of life
- poor suck
- high pitched cry
- stupor
- hypotonia
- seizures

phase 1 of acute bilirubin toxicity

18

middle of first week of life
- hypertonia of extensor muscles
- retrocollis
- fever

phase 2 of acute bilirubin toxicity

19

after the first week of life
- hypertonia

phase 3 of acute bilirubin toxicity

20

first year of life
- active DTR's
- obligatory tonic-neck reflexes
- delayed motor skills

phase 1 of BIND (bilirubin induced neurologic dysfunction)

KNOW this phase!

21

- choreoathetotic cerebral palsy
- ballismus (spontaneous movements)
- tremor
- upward gaze
- dental dysplasia
- sensorineuronal hearing loss
- cognitive impairment

phase 2 of BIND

22

what do you assess for icterus?

the sclera and mucous membranes

23

- jaundice in the first 24
- ABO incompatibility with positive DAT
- hemolytic disease (G6PD, hereditary spherocytosis)
- gestational age 35-36 weeks (preterm)
- previous sibling requiring phototherapy
- cephalohematoma or bruising (from vaccuum delivery)
- exclusive breatfeeding (esp if it's not going well)
- east Asian race

risk factors for severe hyperbilirubinemia

24

what are the 3 biggest risk factors for hyperbilirubinemia?

- prematurity
- high hematocrit at birth
- ABO incompatibility

25

what is the measurement for excessive jaundice in infants?

jaundice to neck = 5
jaundice to waist = 10
jaundice to toes = 15

26

what tests need to be run when TSB increases rapidly or baby is unexpectedly jaundiced upon initial exam?

- BT and DAT (coombs)
- CBC and peripheral smear
- conjugated bili level
- reticulocyte count
- repeat TSB in 4-24 hours

27

what labs should be run when conjugated bilirubin is elevated?

- UA
- blood cultures
- consider intra-hepatic or post-hepatic abnormalities

28

what labs should be run when baby has prolonged jaundice (greater than 3 weeks)?

- TSB, always order fractionated! (need unconj and conjugated)
- check newborn screens (hypothyroid, galactosemia)

29

if baby has jaundice for 2 months, what disease should you consider?

Gilberts

30

- most DC babies at 48 hours of life
- bilirubin greater than 24 hours of life
- DAT in babies born to Type O and Rh neg moms
- folluw up of the newborn within 2 days of DC

hospital protocol