Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
12 Cards in this Set
- Front
- Back
|
What percentage of babies are jaundiced in the first few weeks of life?
|
50%
|
|
|
What is kernicterus?
|
free (unconjugated) bilirubin causing brain damage
|
|
|
Why does free bilirubin like to deposit in the brain?
|
It is water-insoluble.
|
|
|
What causes increased access of free bilirubin to the brain?
|
unwell, pre-term
|
|
|
When would one worry about jaundice?
|
in the first 24h
marked jaundice at any age prolonged jaundice (>2w in term, >3w in pre-term) |
|
|
Ix for jaundice
|
serum bilirubin
blood group and direct Coombs FBE w/film If ethnicity appropriate, G6PD screen If baby unwell, consider inf'n and galactosemia screen. |
|
|
effects of exchange transfusion
|
lowers bilirubin levels (by 50%)
removes hemolyzed RBCs (by 85%) removes antibodies from serum (by 85%) |
|
|
how is exchange transfusion performed?
|
blood removed from umbilical artery catheter
donor blood transfused via IV (double baby's volume for proper effects) SBR must be regularly checked as there can be rebound from residual hemolysis. Some babies will require multiple exchange transfusions. |
|
|
risks of exchange transfusion
|
infection from central lines
thrombo-embolic events metabolic disturbances (esp hypocalcemia and hypoglycemia) |
|
|
When should phototherapy be considered in jaundice over 24-48h of age?
|
commenced at serum bilirubin levels of >300 in babies over 72h of age
(exchange should not be considered until bilirubin exceeds 400-500 and unresponsive to phototherapy) |
|
|
When should phototherapy be stopped?
|
When levels fall <300. Most cases this is within 24-48h of phototherapy.
|
|
|
What is the most important investigation in babies with prolonged jaundice?
What other tests? |
measurement of split bilirubin
(conj. vs unconj. bilirubin) TFTs, urine MC&S/CMV and for reducing sugars, FBE w/film, blood group and direct Coombs liver US, Hep screen, other viral/congenital inf'n studies as appropriate, AAT, metabolic screen HIDA scan, liver Bx if appropriate |
