CLIPP 8

Question 1

describe newborn bilirubin physiology

Answer 1

• bilirubin is created by RBC breakdown
• bilirubin binds to albumin in the blood stream and is transferred to the liver
• liver converts it to conjugated bilirubin (C-B)
• C-B is excreted into the intestines
• Because newborns lak GI flora to convert C-B into urobilin, C-B can be converted back into unconjucagted bilirubin via beta-glucuronidase found in meconium
• unconjucated bilirubin is reabsorbed into the blood stream and binds to albumin (called enterohepatic circulation)

Question 2

define Kernicterus

Answer 2

Kernicterus is the pathological term used to describe staining of the basal ganglia and cranial nerve nuclei by bilirubin.

“Kernicterus” also describes the chronic clinical condition that results from the toxic effects of high levels of unconjugated bilirubin.

Question 3

what are the etiologies of early newborn jaundice? (7)

Answer 3

physiologic jaundice

jaudice associated with breast feeding

hemolysis

non-hemolytic red cell breakdown

neonatal sepsis

congenital infection

metabolic errors

Question 4

what are the etiologies of physiologic jaundice?

Answer 4

• physiologic jaundice
  
  • increased bilirubin production
  • deficiency of UDPGT
  • lack of intestinal flora to metabolize bile
  • high levels of β-glucuronidase in meconium
  • Minimal oral (enteral) intake in the first 2-4 days of life, resulting in slow excretion of meconium (especially common with breastfed infants).

Question 5

what are the etiologies of jaundice associated with breastfeeding?

Answer 5

• jaundice associated with breastfeeding
  
  • breastfeeding jaundice (low intake decreases gut motility -> -> increased unconjugated bilirubin absorption)
  • breast milk jaundice (beta-glucuronidase in breast milk increases unconjucated bili production -> -> increased unconjugated bilirubin absorption)

Question 6

what are the etiologies of jaundice associated hemolysis?

Answer 6

Rh incompatability

ABO incompatability

incompatabilitis with monor blood group antigens (much less common)

Question 7

what are the etiologies of jaundice associated non-hemolytic red cell breakdown?

Answer 7

extensive bruising from birth trauma

large cephalohematoma or other hemorrhage

polycythemia

swallowed blood during delivery

Question 8

what are the etiologies of jaundice associated metabolic errors?

Answer 8

crigler-najjar

gilbert syndrome

galactosemia

Question 9

what is the typical breastfeeding pattern?

Answer 9

every 2-4 hours, 10-15 minutes per breast

Question 10

name some hereditary forms of hemolysis

Answer 10

spherocytosis

elliptocytosis

G6PD

pyruvate kinase deficiency

thalassemias

sickle cell anemia

Question 11

what are common signs of biliary atresia

Answer 11

jaundice

dark urine

acholic (pale) stools

Question 12

What is the name of the procedure that fixes biliary atresia?

Answer 12

Kasai procedure (anastomosis of the intrahepatic bile ducts to a loop of intestine to allow bile to drain directly into the intestine)

Question 13

By what day should meconium stools disappear?

Answer 13

day 3

Question 14

What is a cephalohematoma? does it cross the suture line?

Answer 14

subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery.

no

Question 15

What is a caput succedaneum? does it cross the suture line?

Answer 15

edematous swelling over the presenting portion of the scalp of an infant and is commonly seen in babies born vaginally in vertex position

yes

Question 16

what is the average diameter of the anterior fontanelle?

Answer 16

2.5 - 5 cm

Question 17

When should vitamin D supplementation begin?

Answer 17

400 IU within days of birth

Question 18

when should iron supplementation begin?

Answer 18

4-6 months

Question 19

When should fluoride supplementation begin?

Answer 19

6 months if water does not contain fluoride