Pediatrics
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| __% of infants develop jaundice in the 1st week | 65
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| Jaundice that appears on days 2-3 and disappears by day 7 (day 14 if premature) is called: | Physiologic jaundice
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| __ fed babies are at higher risk for physiologic jaundice | Breast
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| Jaundice with bilirubin >5mg/dL | Clinical jaundice
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| What is the bodily progression of jaundice | Cephalocaudal: starts at the head and moves down
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| In elevated conjugated bilirubin, suspect: | biliary atresia
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| Unconjugated hyperbilirubinemia that results from increase in RBC destruction (antibody mediated hemolysis) is Coombs: | positive
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| Non-immune hemolysis is Coombs: | Negative
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| How does phototherapy work for unconjugated hyperbilirubinemia? | Unconjugated bilirubin in skin is converted to water soluble isomers that are excreted without conjugation
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| Risks for physiologic jaundice | Preterm. Affected sibling. Asian > white > AA. Breastfeeding-associated jaundice is common. Tx = phototherapy
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| 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 ).
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| Pathologic unconjugated bilirubinemia: causes related to decreased conjugation rate | UDPGT deficiency. Crigler-Najar syndrome. Gilbert syndrome.
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| Gives a direct reaction in the van den Bergh test: | Conjugated bilirubin
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| Can cross placenta & is conjugated by mom’s enzymes | indirect/unconjugated bili
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| Water-soluble; placenta is impermeable to: | Direct/conjugated bili
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| Serious, rare, permanent deficiency of glucuronosyltransferase that results in severe indirect hyperbilirubinemia | Crigler-Najjar syndrome
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| Unconjugated bili without hemolysis (usually ≤20 mg/dL) is likely to be due to: | Breast milk jaundice
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| Jaundice >2 wks after birth = | Pathologic; probably direct bilirubinemia (DBil >2 or >20% of TBil)
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| Begin phototherapy when indirect bili = | 16-18 mg/dL
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| Conjugated hyperbilirubinemia is always: | pathologic
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| Jaundice involving the face: total serum bili is approximately: | 5 mg/dL
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| Jaundice involving the abdomen: total serum bili is approximately: | 15 mg/dL
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| Jaundice involving the feet: total serum bili is approximately: | 20 mg/dL
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