Gi_Pm_Peds_Jaundice&breastfeeding

Front 1

Types of Jaundice in Newborn

Back 1

1. Increased Production of Bilirubin (normal to infants)--due to fetal Hb (try to steal O2 from mom)
2. Higher Conc. of Hb = elevated Hct--more RBCs
3. Immune Mediated --most commone (Rh {older problem}, 3a:ABO incompats, and
3b: Red cell membrane Defects,
3c: Heritable Causes: Inc Production/Dec Secretion

how much per day?

Hint 1

Daily 200-400mg
--Most pooped/reabsorbed
-0-4mg excreted

Front 2

What are 4 RBC membrane defects which cause inc. breakdown = inc bilirubin = Newborn jaundice?

Back 2

Spherocytosis
Elliptocytosis
Stomatocytosis
Pyknoctosis

Front 3

How is most bilirubin in babies excreted?
Implications?

Back 3

Thru stool
--If ileus, then too much time to reabsorb = inc levels
--Think POOP in newborn with HerBilirubinemia

Front 4

Which Red Cell Deficiences cause Inc Bili?
name 2

Back 4

G6PD Deficiency
Pyruvate Kinase Deficiency
--others too

What 2 Hb-opathies cause Inc Bili?

Hint 4

Alpha and Beta Thalassemia

Front 5

What are the 3 import MOA for INcreased EnteroHepatic Circulation of Bilirubin leading to inc. levels and jaundice?

Back 5

Breast Milk Jaundice
Pyloric Stenosis
SBO or LBO or Ileus

KNOW THESE!
Basically Again its too long POOP in GIT, or in pyloric stenosis its early poop

Front 6

Which sex is at increased risk?

Back 6

Males

What are some other risks, baby or in delivery?

Hint 6

Prev. Sibling jaundiced
East Asian
Oxytocin use in Labor
BIG infant of Diabetic mom
Little Babies
IUGR?
Brusing/Cephalohematoma
35-38 week gestation
-Late or preterm

Front 7

Things to evaluate if Baby is Jaundiced in 1st 24 hours

Back 7

TTL and Conj. Bili
Infant & Maternal Blood Type
Direct Coombs--test ab/ag breakdown (ie if Rh problem)
-CBC with Peripheral Smear
-Reticulocyte Count
?G6PD Levels

What will peripheral smear tell you? Reticulocyte Count?

Hint 7

If there's Spherocytes, Eliptocytes Pikno cells etc.

Retic Count: rate of Red Cells from BM (~6, much lower for adults)

Front 8

Things to evaluate if Baby is Jaundiced in AFTER 1st 24 hours

Back 8

Consider all of above if jaundice is significant +:
-Stool Color
-Check Urine for Reducing Substances
-Consider TSH and T-4
-Check parental Heritage

What is change in stool color normally

Hint 8

black/tarry meconium to brown to more yellowish brown

Front 9

What is Kernicterus

Back 9

When Bilirubin crosses BBB and causes Cerebral Palsy

What are risk factors?

Hint 9

Breast Feeding + Less than 40 Weeks Gestation
-Sending Babies home too early

Front 10

What Jaundice is caused by bili that is NOt well metabolized = recycling of bilirubin--enterhepatic circulation--with LATER onset, ~10 days post birth

Back 10

Breast Milk Jaundice -- later onset--babies FAULT

Which is early onset of Breast Milk related that occurs in first 2 days?

Hint 10

Breast FEEDING Jaundice
--babies don't get enough to eat in 1st couple days of life --not enough food=not enough stool passed = inc levels but mothers fault (first timers/ tiredness of mom)

Front 11

What can this sort of Jaundice be related to ?

Back 11

Starvation jaundice as seen in adults is similar to Breast Feeding Jaundice (not inherent to soma, rather external = mom or not enough food)
--24 hours with no caloric intake can lead to a doubling of unconjugated bilirubin

Front 12

What is leading cause of hospital readmission of infants

Back 12

Jaundice in breastfed infants

-Assc with excessive weight loss
-poor feeding/feeding problems
due to technique or infrequent attempts

What is problem here

Hint 12

Can lead to termination of breastfeeding by mom
or Dr. says this "is breast milk jaundice" and tell s her to stop

Front 13

Avoidance of what helps prevent early elevation of bilirubin levels

Back 13

avoid sugar water/ water supplementation

What practice minimizes bilirubin serum elevations?

Hint 13

Intitiation of BF in the 1st hour of life followed by frequent (~2hours) with good instruction

Front 14

What is progression of high bilirubin

Back 14

HyperBili can ressult in neonatal somnolence-->dec feeding-->dec stim of maternal milk produ-->.worsening jaundice

Direct relationship btw POOP Volume/wgt and Serum Bili in breastfed infants.

To Avoid--Best Advice
Early and freq feeds resut in early stooling and decrease in total bilirubin load -GOOD

Front 15

What is link betw early/frequent feeds and stools

Back 15

early results in early stooling and decrease in body total bilirubin load

Front 16

What is AAP recommendation?

Back 16

Frequent feedings (8-10/day) at earliest sign of jaundice

Dr. Maggies advice?

Hint 16

Dont even wait for jaundice to appear

Front 17

If jaundice continues to worsen, decisions are?

Back 17

Continue Observation and Freq Feedings
-Phototherabpy
Supplemnetal/artifical feeds (mom pumps)
-Consult Neonatology

Front 18

What should be the new standard for babies

Back 18

DONT wait 2 weeks after leaving hospital
-Come back 2-3 days

What indicates risk factors for jaundice on followups/how to prevent based on feeding status and weight and POOP?

Hint 18

At risk-- so evaluate feeding if:
-Dec or Minimal urine/stool output
-Weight loss = or > 7% in 24-48 hours (remember followup should be 2-3 days postpartum)
-Poor Latch/weak or inefficient suckling, etc.

Front 19

What if bili rises > .2mg% per hour

Back 19

Phototherapy indicated
Consult

Front 20

What if at or near 0.5mg% per hour

Back 20

Consult
Anticipate drastic therapy

Front 21

With Phototherapy, how does it remove bili

Back 21

Aids in removal via renal routes

Anticipate a bounce?

Hint 21

Bounce back 3-5mg% after turning light off

Front 22

If not photoTx, then what?

Back 22

Exchange transfusion
--prolly get neonatologist expertise
-not for faint of heart