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Jaundice

Pediatrics

QuestionAnswer
__% of infants develop jaundice in the 1st week 65
Jaundice that appears on days 2-3 and disappears by day 7 (day 14 if premature) is called: 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 Cephalocaudal: starts at the head and moves down
In elevated conjugated bilirubin, suspect: biliary atresia
Unconjugated hyperbilirubinemia that results from increase in RBC destruction (antibody mediated hemolysis) is Coombs: positive
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. Breastfeeding-associated jaundice is common. Tx = phototherapy
Pathologic unconjugated bilirubinemia: causes related to increased production: Increased RBC destruction due to antibody-mediated hemolysis (ABO or Rh incompatibility). Nonimmune (hereditary spherocytosis, G6PD, cephalohematoma, polycythemia, ileus ).
Pathologic unconjugated bilirubinemia: causes related to decreased conjugation rate UDPGT deficiency. Crigler-Najar syndrome. 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
Unconjugated bili without hemolysis (usually ≤20 mg/dL) is likely to be due to: Breast milk jaundice
Jaundice >2 wks after birth = Pathologic; probably direct bilirubinemia (DBil >2 or >20% of TBil)
Begin phototherapy when indirect bili = 16-18 mg/dL
Conjugated hyperbilirubinemia is always: pathologic
Jaundice involving the face: total serum bili is approximately: 5 mg/dL
Jaundice involving the abdomen: total serum bili is approximately: 15 mg/dL
Jaundice involving the feet: total serum bili is approximately: 20 mg/dL
Created by: Abarnard
 

 



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