|
Chapter 1 Index
A. General Information
about the well child examination
--Prenatal Visit
--Well Child Check-up |
|
Neonatal Jaundice
Introduction: Jaundice occurs in 60% of term infants and
80% of preterm infants in the first week of life. Physiologic jaundice is
defined as: elevation of bilirubin due to both the breakdown of fetal RBCs
and the immature conjugation ability of liver in newborn.
When is a bilirubin abnormal?
- Any visible jaundice in 1st day of life (br usually 5-7 mg/dl to be
visible)
- Indirect br >12.9 in preterm infants or > 15 in term infants
- If jaundice has persisted more than 2 weeks
- Anytime the bilirubin rises > 5 mg/dl/day
- Any elevation of the direct fraction of the bilirubin > 1 mg/dl.
Important Questions need to get answered when evaluating jaundice:
- Is the mother breastfeeding, and if so, is she having trouble? 1 in 3
breast fed infants still jaundiced at 2 weeks of age. Must distinguish
jaundice associated with problems with breastfeeding (breastfeeding
jaundice) from breast milk jaundice.
- Have the stools transitioned yet? Less likely severe jaundice if has.
- Is their blood group incompatibility? e.g. ABO ir Rh.+Coombs doesn’t
always mean there is going to be trouble.
- Did siblings have jaundice in the newborn period? If yes, more likely
to have problems
- Is the infant preterm? Even 37 week babies are 4X more likely to have
jaundice than 40wk
- Could the baby be infected? As only sign of sepsis, jaundice is rare,
however. Some infections such as syphilis, rubella, toxo, CMV more likely
have later onset.
- Is the mother diabetic? Because of polycythemia, more likely to have
jaundiced babies
- What is the baby’s ethnic origin? e.g. enzyme problems more likely if
from mid-east
- What are stool and urine color? White/clay colored stool: biliary
atresia.
Physical Examination:
- Caudal progression: 5 mg at face, 15 at umbilicus, 20 soles of feet.
Arch Peds 2000: clinical examination neither reliable nor accurate: best
when to nipple line: no br needed.
- Others: weight loss, bruising, cephalohematoma, hepatosplenomegaly,
rashes; also muscle tone, macroglossia, and large ant font: suggests
hypothyroidism
Lab Data: Obtained in some, not all jaundiced babies:
List could include:
- Type, RH and Coombs, CBC for Hb, Hct, WBC (infection)
- Peripheral smear; reticulocyte count; total/direct bilirubin.
Treatment of Jaundice: Reason to treat: prevent Kernicterus (rare
below 25 mg/dl)
Phototherapy: Works by absorbing light in blue range (425-475 nm). The
lights cause a photoisomerization reaction, which allows bilirubin to be
excreted. Lights should be 15- 20 cm away from the baby; maximum skin
should be exposed (leave undiapered).
Levels of bilirubin for which phototherapy indicated: (flexible): 15-18
at 24-48 hrs of life18-20 at 48-72 hours of life); > 20 after 72 hours of
life
Next Page |