Pediatrics Newborn Hyperbilirubinemia Flashcards
(27 cards)
What type of newborn Hyperbilirubinemia is most common
Unconjugated (indirect)
How long after birth does Bilirubin usually peak
2-4 days
What is the normal infant peak for Bilirubin
8mg/dL
At what level of Bilirubin does Neonatal jaundice usually develop
> 2 to 3mg/dL
At what Bilirubin level does neurologic damage occur
> 25 mg/dL
What is the Bhutani Nomogram
Chart to ID infants risk of severe hyperbilirubinemia
What Causes Bilirubin-Induced Neurologic Dysfunction (BIND)
Unconjugated Bilirubin is fat-soluble and crosses the BBB to act as a neurotoxin
-Basal Ganglia
-Brain stem Nuclei
How does BIND initially present
Lethargy
Hypotonia
What can untreated BIND progress to
Coma
Seizures
Opisthotonos
Retrocollis
What is Opisthotonos
Back Spasm
-head and legs bend backward
-trunk arches forward
What is Retrocollis
Backward arching of the neck
What is Kernicterus (Chronic Bilirubin Encephalopathy)
Permanent Neurologic damage from Hyperbiliurbinemia
How does Kernicterus present
Cerebral Palsy (CP)
Hearing Loss
Gaze Abnormalities
Dental Hypoplasia
How to treat Indirect Hyperbilirubinemia
Phototherapy
-converts bilirubin to Lemirubin
-more Water soluble
-excreted without conjugation
What are the causes of Indirect Hyperbilirubinemia
Physiologic
Breast Milk Jaundice
Breast Feeding Jaundice
Hemolysis
Rare Causes
What Causes Breast Milk Jaundice
The enzyme Beta-Glucuronidase in breast milk
-increased GI absorption of unconjugated Bilirubin
When Does Breast Milk Jaundice appear
day 3-4
When does Bilirubin peak in Breast Milk Jaundice
within 2 weeks
How does the baby appear in Breast Milk Jaundice
Feeds Well
Appears Healthy
What is the treatment for Breast Milk Jaundice
No treatment required
What caused Breastfeeding Jaundice
Inadequate lactation
-inadequate fluids
-inadequate calories
-increases enterohepatic circulation
When does Breastfeeding Jaundice Appear
1st week of life
How does Breastfeeding Jaundice present
Hypovolemia
Weight loss
S/S of volume depletion on exam
When does Hemolysis induced Jaundice occur
first 24 hours of life
