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;
50 Cards in this Set
- Front
- Back
What is considered to be the neonatal period?
|
The first 28 days of life
|
|
What is the period from birth to six days considered to be?
|
Early neonatal period
|
|
What is the period after birth 7 through 27/28 days of age (first lunar month)?
|
Late neonatal period
|
|
Newborns produce bilirubin at a rate of approximately ?
|
6-8mg per kg per day
|
|
Bilirubin production typically declines to the adult level within
|
10-14 days
|
|
Water soluble bilirubin is?
|
BC = conjugated or Direct bilirubin it is Water soluble
|
|
diazo reagent + blood specimen =
|
Azobilirubin = Direct Bilirubin
|
|
This bilirubin is not water soluble?
|
BU = unconjugated or indirect bilirubin is NOT water soluble
Reaction: Reacts more slowly. Still binds with diazo reagent and forms azobilirubin but needs Ethanol therefore the measurement of this bilirubin is “indirect”. |
|
Indirect bilirubin =
|
Total bilirubin – Direct bilirubin
|
|
Total Bilirubiin =
|
BU (end conjugated bilirubin) + BC
|
|
refers to the neurologic consequences of the deposition of unconjugated bilirubin in brain tissue.
This can cause Subsequent damage and scarring of the basal ganglia and brain-stem nuclei may occur. |
Kernicterus
|
|
Physiologic jaundice of the newborn is a result of ?
|
the immature liver's lacking sufficient conjugating enzymes.
|
|
The newborn's inability to conjugate bilirubin results in?
|
high circulating blood levels of unconjugated bilirubin, which, if untreated, passes through the blood-brain barrier.
|
|
Indirect bilirubin is calculated from the?
|
total and direct bilirubin.
|
|
Bilirubin levels can be decreased by exposing newborns to?
|
ultraviolet light.
|
|
Infants without identified risk factors rarely have total serum bilirubin levels above ?
|
12 mg per dL (205 µmol per L).
|
|
What level is the bilirubin in a newborn if it is visible in the skin?
|
>5mg/dl
|
|
What are the levels of biliribun when visible at the following locations?
Face Upper trunk Lower trunk & thighs Arms and lower legs Palms & soles |
Face 4-8
Upper trunk 5-12 Lower trunk & thighs 8-16 Arms and lower legs 11-18 Palms & soles > 15 |
|
Appears after 24 hours
Maximum intensity by 4th-5th day in term & 7th day in preterm Serum level less than 15 mg / dl Clinically not detectable after 14 days Disappears without any treatment |
Physiological Jaundice
|
|
Why does physiologic jaundice develop?
|
Increased bilirubin load
Defective uptake from plasma Defective conjugation Decreased excretion Increased entero-hepatic circulation |
|
Appears within 24 hours of age
Increase of bilirubin > 5 mg / dl / day Serum bilirubin > 15 mg / dl Jaundice persisting after 14 days Stool clay / white colored and urine staining clothes yellow Direct bilirubin> 2 mg / dl |
Pathological Jaundice
|
|
Causes for jaundice Appearing within 24 hours of age
|
Hemolytic disease of NB : Rh, ABO
Infections: TORCH, malaria, bacterial G6PD deficiency |
|
Causes of jaundice Appearing between 24-72 hours of life
|
Physiological
Sepsis Polycythemia Concealed hemorrhage Intraventricular hemorrhage Increased entero-hepatic circulation |
|
Causes of jaundice after 72 hours of age
|
Sepsis
Cephalhaematoma Neonatal hepatitis Extra-hepatic biliary atresia Breast milk jaundice Metabolic disorders |
|
RISK FACTORS FOR JAUNDICE:
J A U N D I C E |
J - jaundice within first 24 hrs of life
A - a sibling who was jaundiced as neonate U - unrecognized hemolysis N – non-optimal sucking/nursing D - deficiency of G6PD I - infection C – cephalhematoma /bruising E - East Asian/North Indian |
|
What are common causes of jaundice?
|
Exaggerated physiological
Blood group incompatibility – ABO,Rh G6PD deficiency Bruising and cephalhematoma Intrauterine and postnatal infections Breast milk jaundice |
|
Calorie deprivations
Decreased volume and frequency of feedings = mild dehydration and delayed passage of meconium BF babies 3-6 x more likely to experience moderate jaundice (Total serum bilirubin level above 12 mg/dL) or severe jaundice (Total serum bilirubin level above 15 mg/dL) |
Early onset breastfeeding jaundice
|
|
Causes not entirely understood. May be that some substances in maternal milk may inhibit normal bilirubin metabolism.
May substitute formula if serum bilirubin goes up; after 48 hours of formula substitution breastfeeding can be resumed if bilirubin level declines rapidly (indicating BF jaundice). |
Late-Onset Breast Milk Jaundice
|
|
What is the approach to a jaundice baby?
|
Ascertain birth weight, gestation and postnatal age
Ask when jaundice was first noticed Assess clinical condition (well or ill) Decide whether jaundice is physiological or pathological Look for evidence of kernicterus* in deeply jaundiced NB *Lethargy and poor feeding, poor or absent Moro's, opisthotonus or convulsions |
|
What is the workup for a jaundice baby?
|
Maternal & perinatal history
Physical examination Laboratory tests (must in all)* Total & direct bilirubin* Blood group and Rh for mother and baby* Hematocrit, retic count and peripheral smear* Sepsis screen Liver and thyroid function TORCH titers, liver scan when conjugated hyperbilirubinemia |
|
What is the management for a jaundice baby?
|
Rationale: reduce level of serum bilirubin and prevent bilirubin toxicity
Prevention of hyperbilirubinemia: early feeds, adequate hydration Reduction of bilirubin levels: phototherapy, exchange transfusion, drugs |
|
Native bilirubin that is insoluble is exosed to what in order to create soluble photo isomers of bilirubin?
|
450-460nm of light
|
|
How do you perform phototherapy?
|
Perform hand wash
Place baby naked in cradle or incubator Fix eye shades Keep baby at least 45 cm from lights, if using closer monitor temperature of baby Start phototherapy |
|
What are six important things to know with phototherapy?
|
Frequent extra breast feeding every 2 hourly
Turn baby after each feed Temperature record 2 to 4 hourly Weight record- daily Monitor urine frequency Monitor bilirubin level |
|
What are the side effects of phototherapy?
|
Increased insensible water loss
Loose stools Skin rash Bronze baby syndrome Hyperthermia Upsets maternal baby interaction May result in hypocalcemia |
|
What are the causes of prolonged indirect jaundice?
|
Crigler Najjar syndrome
Breast milk jaundice Hypothyroidism Pyloric stenosis Ongoing hemolysis, malaria |
|
What are two things that would make you suspect conjugated hyperbilirubinemia?
|
High colored urine
White or clay colored stool Always refer to hospital for investigations so that biliary atresia or metabolic disorders can be diagnosed and managed early |
|
What are the causes of conjugated hyperbilirubinemia?
|
Idiopathic neonatal hepatitis
Infections -Hepatitis B, TORCH, sepsis Biliary atresia, choledochal cyst Metabolic -Galactosemia, tyrosinemia, hypothyroidism Total parenteral nutrition |
|
What is the differential diagnosis of respiratory distress syndrome?
|
1- Transient tachypnea of newborn
2- Congenital heart disease 3- Hyaline membrane disease 4- Neonatal sepsis 5- Hyperviscosity syndrome |
|
Most common cause of respiratory distress.
40% cases. Residual fluid in fetal lung tissues. Risk factors- maternal asthma, c- section, male sex, macrosomia, maternal diabetes |
Transient tachypnea of newborn
|
|
Tachypnea immediately after birth or within two hours, with other predictable signs of respiratory distress.
Symptoms can last few hours to two days. Chest radiography shows diffuse parenchymal infiltrates, a “ wet silhouette” around heart, or intralobar fluid accumulation |
Transient Tachypnea of Newborn
|
|
What will an X-Ray show with transient tachypnea of newborn?
|
Fluid in the fissure
|
|
Also called as hyaline membrane disease
Most common cause of respiratory distress in premature infants, correlating with structural & functional lung immaturity. 1/3 infants born between 28 to 34 weeks, but less than 5% of those born after 34 weeks. Pathophysiology- surfactant deficiency- increase in alveolar surface tension- decrease in compliance. |
Respiratory distress syndrome
|
|
Hyaline membrane- combination of sloughed epithelium, protein & edema.
Diagnosis of respiratory distress should be suspected when grunting, retraction or other typical distress symtoms occur in premature infant. CXR- homogenous opaque infiltrates & air bronchograms. |
Respiratory distress syndrome
|
|
Incidence- 1.5- 2 % in term or post term infants.
Meconium is locally irritative, obstructive & medium for for bacterial culture Meconium aspiration causes significant respiratory distress. Hypoxia occurs because aspiration occurs in utero. CXR- Patchy atelectasis or consolidation. |
Meconium aspiration syndrome
|
|
Risk factors- prolonged rupture of membranes, prematurity,& maternal fever.
|
risk factors for infection
|
|
What will you see on CXR with an infection?
|
CXR- bilateral infiltrates suggesting in utero infection.
|
|
The following are caused by what?
Pulmonary hypoplasia, congenital emphysema, esophageal atresia & diaphragmatic hernia. |
Congenital Malformations
|
|
What is a cause for the following?
hydrocephalus & intracranial hemorrhage. |
Neurological causes
|
|
What can cause hypoglycemia, hypocalcemia, polycythemia?
|
Metabolic Derangements
|