Term
| What causes jaundice to develop? |
|
Definition
unconjugated bilirubin accumulates faster than liver can clear it because:
-slow gut
-absence of intestinal bacteria |
|
|
Term
| Physiologic jaundice peaks at ___?___ days. |
|
Definition
|
|
Term
| What are factors that increase the risk of unconjugated hyperbilirubinemia? |
|
Definition
-asphyxia
-cold stress
-hypoglycemia
-maternal salicylate ingestion |
|
|
Term
| What is the etiology of kernicterus? |
|
Definition
-high levels of unconjugated serum bilirubin deposit in basal ganglia
-encephalopathy |
|
|
Term
| What are early and late signs of kernicterus? |
|
Definition
Early:
-lethargy
-hypotonia
-poor suck
Late:
-hypertonia
-irritability
-retrocollis: backward arching of neck
-opisthonos: backward arching of trunk
-high-pitched or shrill cry |
|
|
Term
| What are features of chronic postkernicteric encephalopathy? |
|
Definition
-atheoid movements: uncontrolled, rhythmic, writhing
-gaze abnormalities: limitation of upward
-sensorineural hearing loss
-intellectual deficits: MR
-dental dysplasia
-irreversible |
|
|
Term
| What are causes of and risk factors for hyperbilirubinemia? |
|
Definition
-increased rate of hemolysis: elevated reticulocyte count
---antibody-mediated hemolysis: ABO or Rh incompatibility
---non-immune: hereditary spherocytosis, G6PD, other metabolic defects
---sepsis
-non-hemolytic
---extravascular hemorrhage: cephalhematoma
---polycythemia
---exaggerated enterohepatic circulation of bilirubin: GI obstruction, paralytic ileus
-decreased rate of conjugation
---physiologic jaundice: UDPGT inactivity, high red cell mass, absence of intestinal flora
---Crigler-Najjar syndrome
---Gilbert's syndrome
---hypothyroidism
-high altitude
-Asian race
-prematurity
-breastfeeding |
|
|
Term
| What are the criteria for physioloic jaundice? |
|
Definition
-onset after 24 hours
-total bili rises < 5 mg/dl/day
-peak bili at 3-5 days
-peak bili < 15 mg/dl
-jaundice resolved by 1 week full term, 2 weeks premature |
|
|
Term
| What are major risk factors for severe hyperbilirubinemia? |
|
Definition
-high TSB or TcB pre-discharge
-jaundice in 1st 24 hours
-blood group incompatability with (+) direct antiglobulin test, other hemolytic dz, elevated ETCOc
-gestational age 35-36 weeks |
|
|
Term
| What is the etiology of breast milk jaundice? |
|
Definition
| a substance in breast milk inhibits conjugation, causing prolonged unconjugated hyperbilirubinemia |
|
|
Term
| What are features of breast milk jaundice? |
|
Definition
-peaks at 10-15 days
-declines slowly after 3-12 weeks
-peaks at 10-30 mg/dl |
|
|
Term
| What is the treatment of breast milk jaundice? |
|
Definition
| interrupt breast feeding x24-48 hours |
|
|
Term
| Clinical jaundice appears at ___?___ mg/dl, progression from head downward. Jaundice appears on distal extremities at ___?___ mg/dl. However, baby's color is not a reliable indication of levels. |
|
Definition
clinical: 5 mg/dl
extremities: 15 mg/dl |
|
|
Term
| What are the labs for hyperbilirubinemia and their meanings? |
|
Definition
-total bili: combined direct and indirect
-direct bili: conjugated; low in physiologic jaundice
-indirect bili: unconjugated; elevated in increased enterohepatic circulation jaundice
-blood type
-Coombs test
-CBC with smear\ |
|
|
Term
| What are normal levels of direct/conjugated bili? |
|
Definition
|
|
Term
| Which labs should be done when jaundice appears in 1st 24 hours or appears excessive? |
|
Definition
|
|
Term
| Which labs should be done when phototherapy is used, and TSB rising without explanation? |
|
Definition
-blood type
-Coomb's
-CBC with smear
-direct bili
-retic count
-G6PD
-repeated TSB in 4-24 hours |
|
|
Term
| Which labs should be done when TSB close to exchange levels or not responding to therapy? |
|
Definition
-retic count
-G6PD
-albumin |
|
|
Term
| Which labs should be done when direct conjegated bili is elevated? |
|
Definition
-UA and UC
-sepsis w/u if indicated |
|
|
Term
| Which labs should be done when jaundice persists beyond 3 weeks of age or infant is sick? |
|
Definition
-total and direct bili (evaluate for cholestasis if elevated)
-thyroid
-galactosemia
-hypothyroid |
|
|
Term
| What is the Bhutani scale? |
|
Definition
| normogram for designation of low, low intermediate, high intermediate, and high risk of sever hyperbilirubinemia |
|
|
Term
| When is phototherapy indicated? |
|
Definition
age 2 days: >/= 15 mg/dl
age 2-3 days: >/= 18 mg/dl
age 3-4 days: >/= 20-22 mg/dl
>/= 25 mg/dl |
|
|
Term
| When should interruption of breastfeeding/formula supplementation be considered? |
|
Definition
|
|
Term
| When should blood transfusion be considered? |
|
Definition
|
|
Term
| How does phototherapy address hyperbilirubinemia? |
|
Definition
| molecule absorbs energy causing a structural change that is more soluble and excretable |
|
|
Term
| What are complications of phototherapy? |
|
Definition
-cell damage
-DNA damage
-retinal effects
-diarrhea
-dehydration
-financial
-emotional
-"bronze baby" |
|
|
Term
| What are guidelines for monitoring bilirubin decline in phototherapy? |
|
Definition
-4-6h: decline 1-2 mg/dl
-6-12h: repeat total bili
-13-14 mg/dl or declines and plateaus, discontinue |
|
|
