Neonatal Jaundice

Front 1

What is jaundice and when is it visible?

Back 1

Jaundice is the yellowish color to the skin due to deposition of bilirubin in the skin

Visible only after bilirubin is >5mg/dl in serum

Front 2

What is bilirubin?

Back 2

breakdown product of RBC that is a yellow pigment

It can be neurotoxic substance to newborns if too much accumulates

Front 3

What are the risk factors for neonatal jaundice?

Back 3

1.Males
2.vacuum/forceps delivery
3.maternal: fever/GBS status, DM, Blood type I, Rh neg
4.previous siblings with jaundice
5.excessive bruising
6.asian race
7.prematurity
8.breast feeding
9.excessive weight loss

Front 4

Is neonatal jaundice normal? Is it ever worrisome?

Back 4

It usually occurs in 50-60% of all neonates during the 2-5th day of life

It is worriness if it occurs during the first 24 hrs

Front 5

What can indirect (unconjugated) bilirubin cause?

Back 5

It is neurotoxic:

cerebral palsy
seizures
speech disorders
partial deafness
even death

Front 6

What is kernicterus?

Back 6

excessive accumulation of bilirubin in the brain

(basal ganglia, hippocampal cortex, subthalamic nuclei and cerebellum)

Front 7

What causes physiologic jaundice?

Back 7

failure of liver to dipose of normal amts of bilirubin from the breakdown of newborns RBC

This does not cause jaundice in the first day of life

Front 8

What are some criteria to exclused physiologic jaundice?

Back 8

1.UCB>12.9mg/dl-term infant
2.UCB>15mg/dl-preterm infant
3.bilirubin levels increasing>5mg/dl/24hrs
4.jaundice in 1st 24hrs
5.CB>2mg/dl
6.clinical jaundice lasting>1wk in term infants and >2wks in preterm infants

Front 9

How does ABO incompatibility contribute to neonatal jaundice?

Back 9

most common cause of hemolytic disease in newborns

leakage of fetal blood cells into maternal circulation which cause maternal IgA to breakdown babies RBCs

Front 10

In what percentage of pregnancies does ABO incompatibility occur and in what blood types?

Back 10

Mother has to be type O
Fetus has to be type A or B (more common with A)

This occurs in 12% of all pregnancies

Front 11

Is there a test that can check for ABO incompatibility in pts?

Back 11

Yes, + Coombs test, but only sensitization in 3% of pregnancies

Front 12

How does Rh incompatibility contribute to neonatal jaundice?

Back 12

leakage of fetal blood cells into maternal circulation and mother produces Abs against D Ag on fetal blood cells

Cross the placenta barrier and cause hemolysis, which leads to anemia and jaundice

Front 13

Which is more severe, Rh or ABO incompatibility?

Back 13

Rh is more severe, but less common because of Rhogam

Front 14

When might Rh incompatibility occur?

Back 14

Mother has Rh negative
Fetus has Rh positive

Worsens with each pregnancy where the baby is Rh+

Front 15

What are some non-physiological causes of jaundice?

Back 15

breast feeding
RBC enzyme defects
RBC membrane defects
Inherited disorders of bilirubin metabolism

Front 16

How does breast feeding cause non physiologic jaundice?

How can you resolve the jaundice?

Back 16

two ways:
not enough breast milk (worsens with glucose water or water)

Mother's enzymes deactivate babies enzymes

Frequent feedings help resolve and prevent jaundice

Front 17

What are some RBC enzyme defects that cause non-physiologic jaundice?

Back 17

G6PD (glucose 6 phosphate deficiency--may present with severe neonatal jaundice

Pyruvate Kinase deficiency--
leads to decreased lifespan of RBC and hemolysis with resulting neonatal jaundice

Front 18

What are some examples of RBC membrane defects that cause non-physiologic jaundice?

How do they cause jaundice?

Back 18

Hereditary spherocytosis
Hereditary elliptocytosis

Both are related to fragile membranes of cell--leads to hemolysis and then neonatal jaundice

Front 19

What are some disease that deal with a defect in the enzyme UGT?

Back 19

Crigler-Najar Type I(doesn't respond to phenobarbital) and II (responds to phenobarbital)

Lucy-Driscoll Syndrome

Gilbert syndrome

Front 20

What does phenobarbital do?

Back 20

induces UGT activity

Front 21

What is lucy-Driscoll Syndrome?
How do you treat it?

Back 21

unspecified maternal gestational hormone in infants serum that interferes with conjugation of bilirubin that should be considered if siblings experience transient intense hyperbilirubinemia of unknown cause

Resolves spontaneously

Front 22

What is Gilbert's Syndrome?
How many people have this?

Back 22

A mild form of Crigler-Najar Type II.
Pt will turn yellow with stress, fatigue and illness

10-15% of the population might have this

Front 23

How do you visually detect for jaundice?

Back 23

1.blanching skin with digital pressure to reveal underlying color of skin and subcutaneous tissue
2.progresses from head to toe
3.very dependent on experience of caregivers and pigmentation of skin
4. Visual estimations of bilirubin levels: LEAD TO ERRORS
5. usually don't see until serum bilirubin levels are 5-6mg/dl

Front 24

What is a bilimeter (TcB) and how reliable is it?

Back 24

measures the level of bilirubin up to 12mg/dl--anything above 12mg/dl should be confirmed with a serum test

Front 25

How does a serum bilirubin(TSB) test work?

Back 25

requires a blood sample (can be obtained from cord blood if risk factors presents)

can be capillary or venous sample

Front 26

What is the jaundice protocol for the nursery?

Back 26

1. asses infants at least every 8-12 hrs
2.Measure TcB/TSB for infant jaundice in 1st 24hrs
3.Measure TcB/TSB for infants with excessive jaundice for their age
4.Measure TcB/TSB if any question about jaundice levels
5.interpret all TSB and TcB according to their infant's age in HOURS

Front 27

When is bilirubin level considered abnormal?

Back 27

AAP published nomogram in 2004

Based on level of bilirubin and HOURS of age

Front 28

What do risk zone help with?

Back 28

who will and won't develop hyperbilirubinemia

Front 29

How does phototherapy work in treating jaundice?

Back 29

Give irradiance of baby with blue-green spectrum light (430-490nm)

Deliver to as much skin as possible

Front 30

What are the risks of treating jaundice with phototherapy?

Back 30

retinal degeneration
increased insensible fluid loss
Bronze Baby syndrome (with conjugated bilirubin--causes destruction of copper porphyrins--urine and skin become bronze)
Congenital erythropoietic porphyria(RARE): severe bullous lesion on exposed skin...can lead to death

Front 31

What is exchange transfusion?
When is it used?

Back 31

Removal of some of babies blood and replaced with blood without bilirubin

It is done only in the NICU or PICU and in infants that are not responding to phototherapy

Front 32

When do you discontinue treatment of phototherapy?

Is it the same with all babies?

Back 32

when bilirubin is below high risk zone and stable

That level may vary depending on baby

Front 33

Who should receive phototherapy?

Back 33

look at chart for babies >35 wks