Variations in the Normal Term Newborn
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| What are the two types of jaundice? | *Physical jaundice *Pathological jaundice
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| When does physical jaundice occur? | Is not present during the first 24 hours of life in term infants but appears on the second or third day after birth
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| True or False: Jaundice in the 2nd or 3rd day of the newborns life is indicative of an underdeveloped liver and is a critical condition | False. It is physical jaundice and is considered a normal phenomenon
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| At what biliruben level does jaundice occur? | 5-7mg/dL
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| At what biliruben level does jaundice occur in the face? | 5-7mg/dL
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| At what biliruben level does jaundice occur in the midabdomen? | 15mg/dL
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| At what biliruben level does jaundice occur on the soles of the feet? | 20mg/dL
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| When does pathological jaundice occur? | during the first 24 hours after birth
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| What are the nonphysiological causes of pathological jaundice? | *A direct bilirubin level above 1.5 to 2 mg/dl *Total serum bilirubin concentration increasing by more than 0.2 mg/dl per hour or 5 mg/dl per day *Clinical jaundice that lasts more than 2 weeks in a full term infant
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| What are the most common causes of pathological jaundice? | *Abnormalities causing excessive destruction of erythrocytes *Incompatibilities between mother’s and infant’s blood types *Infection *Metabolic disorders
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| What can severe jaundice lead to? | Kernicterus
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| What is kernicterus? | damage to the brain centers of infants caused by increased levels of unconjugated bilirubin
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| Infants who survive kernicterus may suffer from what? | *Cerebral palsy *Mental retardation *Hearing loss *More subtle long-term neurologic and developmental problems
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| List four factors that increase hyperbilirubinemia in newborns: | *Hemolysis of excessive erythrocytes *Short red blood cell life *Rh incompatibility with mother *Infection *Liver immaturity *Lack of intestinal flora *Delayed feeding *Bruising or cephalohematoma *Fatty acids from cold stress or asphyxia
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| What is the most common Tx of bilirubenemia in newborns? | Phototherapy is most common treatment and involves placing the infant under special fluorescent lights
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| What intervention is done when phototherapy cannot reduce a newborns bili levels quick enough? | Exchange transfusion
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| What is an exchange transfusion? | Donor blood is givin through the umbilical vein and newborns waste blood is drained from the umbilical artery.
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| What is erythema toxicum? | A benign rash of unknown cause in newborns, blotchy red areas that may have white or yellow papules or vesicles in the center
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| When does erythem toxicum occur? | Rash appears during the first 24 to 48 hours after birth, although occasionally as late as 1 to 2 weeks
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| Where is erythema toxicum most commonly located on the newborn? | face, back, shoulders, and chest
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| What is the differential Dx of erythem toxicum? | pustular rash cause by staph infection or vesicles from herpes simplex
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| How long does erythema toxicum last? | Hours to 10 days
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| What are mongolian spots? | Bluish black marks that resemble bruises
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| Where do brown spots usually occur? | Sacral area
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| Who are mongolian spots most common in? | Newborns with dark skin
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| What are Petechiae? | Pinpoint bruises that resemble a rash
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| What causes petechiae? | Increased intravascular pressure
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| What can petechiae indicate? | infection or a low platelet count
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| What is Nevus Simplex? | Flat, pink, or reddish discoloration that is usually on face or neck and disappears by 2 years of age
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| What is Nevus Flammeus (Port Wine Stain)? | Permanent, flat, dark, reddish-purple mark that varies in size and location. Can be removed by laser surgery
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| What is Nevus Vasculosus (Strawberry Hemangioma)? | Enlarged capillaries in the outer layer of skin that makes the skin appear dark red and raised with a rough surface
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| What is the Tx of nevus vasculosus? | No Tx necessary
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| What is Cutis Marmorata? | A lace-like red or blue pattern on the skin that is caused by cold stress, overstimulation, hypovolemia, or sepsis
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| What may cutis marmorata indicate? | Chromosomal abnormality
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| What is Harlequin Color Change? | Deep red color over half of body with pallor on the other half of the body
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| What causes harlequin color change? | Cause is unknown, though it usually occurs with preterm infants who are placed on their side
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| What is acrocyanosis? | Peripheral cyanosis that appears on hands and feet.
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| When is acrocyanosis common? | during the first day and is a result of poor peripheral circulation
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| What is the most common surgical procedure of the neonate? | Circumcision
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