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Peds Bilirubin


__% of infants develop jaundice in the 1st week 65
Jaundice that appears on days 2-3 and disappears by day 5 is __ Physiologic jaundice
__ fed babies are at higher risk for physiologic jaundice Breast
Jaundice with bilirubin >5mg/dL Clinical jaundice
What is the bodily progression of jaundice Starts at the head and moves down
Elevated conjugated bilirubin, think: biliary atresia
Unconjugated hyperbilirubinemia that results from increase in RBC destruction – antibody mediated hemolysis is Coombs __ +
Non-immune hemolysis is Coombs __ Negative
How does phototherapy work for unconjugated hyperbilirubinemia Unconjugated bilirubin in skin is converted to water soluble isomers that are excreted without conjugation
Risks for physiologic jaundice preterm; affected sibling; Asian>white>AA; BF-assoc jaundice is common; tx = phototherapy
Pathologic unconj bilirubinemia: causes: Increased production: Increased RBC destruction d/t Ab-mediated hemolysis; nonimmune = spherocytosis, G6PD, cephalohematoma, polycythemia, ileus
Pathologic unconj bilirubinemia: causes: decreased conj rate UDPGT deficiency; Gilbert syndrome
gives a direct reaction in the van den Bergh test Conjugated bilirubin
can cross placenta & is conjugated by mom’s enzymes indirect/unconjugated bili
Water-soluble; placenta is impermeable to: Direct/conjugated bili
serious, rare, permanent deficiency of glucuronosyltransferase that results in severe indirect hyperbilirubinemia Crigler-Najjar syndrome
unconj bili w/o hemolysis; usu ≤20 mg/dL Breast milk jaundice
Jaundice >2 wks after birth = pathologic; prob direct bilirubinemia (DBil >2 or >20% of TBil)
Begin phototherapy when indirect bili = 16-18 mg/dL
Created by: Adam Barnard Adam Barnard