1 / 18

Good Morning!

Good Morning!. July 19, 2012. Semantic Qualifiers. Illness Script. Predisposing Conditions Age, gender, preceding events (trauma, viral illness, etc ), medication use, past medical history (diagnoses, surgeries, etc ) Pathophysiological Insult

marina
Download Presentation

Good Morning!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Good Morning! July 19, 2012

  2. Semantic Qualifiers

  3. Illness Script • Predisposing Conditions • Age, gender, preceding events (trauma, viral illness, etc), medication use, past medical history (diagnoses, surgeries, etc) • Pathophysiological Insult • What is physically happening in the body, organisms involved, etc. • Clinical Manifestations • Signs and symptoms • Labs and imaging

  4. Predisposing Conditions Physiologic Jaundice** • Newborns in first full week of life…almost universal • Sibling with history of jaundice/requiring phototherapy • Asian ethnicity • Prematurity • Maternal diabetes • Breastfed infants** • Breast feeding is the most common cause of exaggerated unconjugated hyperbilirubinemia** • Breastfeeding (1st week), Breast milk (6-14 days)**

  5. Pathophysiology** Physiologic Jaundice

  6. Clinical Manifestations Physiologic Jaundice • Peak bilirubin concentration at 3-5 days • Breast milk jaundice can persist for 1-3 months • Jaundice • Serum bilirubin concentrations of >4-5mg/dL in infants • >2-3mg/dL in older children • Scleral icterus • Elevated total bilirubin • Unconjugated hyperbilirubinemia • NOT conjugated/direct hyperbilirubinemia** • >2mg/dL direct or >20% total bilirubin level • This is PATHOLOGIC

  7. Evaluation • After birth, infants should be assessed for jaundice every 8-12h (at least TcB) • Plot to determine what “risk-zone” • Obtain serum measurement if elevated • When to do more tests** • Jaundice in first 24 hours • Any infant receiving phototherapy • When TSB crosses percentiles on the nomogram • What tests • CBC with smear, reticulocyte count, Coombs test** • To detect hemolytic disease (ABO/Rh incomp, G6PD, etc.)** • Direct bilirubin concentration

  8. Screening Prior to Discharge**

  9. **Sepsis/UTI, metabolic disorders, and endocrine disorders can cause hyperbili…indirect or direct and should be screened for if clinically indicated!

  10. Management • Helping mother’s breastfeed appropriately can decrease the likelihood of severe hyperbili** • Every 8-12 hours • Typically feed through breast milk/breastfeeding jaundice unless diagnosis in question or clinical reason not to!** • Lactation consultation when needed • Phototherapy** • Initiation based on TSB and age in hours** • Converts bilirubin into a water-soluble compound that can be excreted in urine or bile without conjugation • Blue lights in 460-490nm wavelength • More exposure = better • Expect a decrease of 0.5mg/dL/hr in first 4-8 hours • NOT for direct hyperbili (bronze infant syndrome) • Exchange transfusion

  11. Phototherapy

  12. Exchange Transfusion

  13. Importance • Bilirubin crosses the BBB if unconjugated and unbound to albumin • Acute bilirubin encephalopathy** • Phase 1: first 1-2 days; poor suck, high-pitched cry, stupor, hypotonia, seizures • Phase 2: middle of 1st week; hypertonia of extensor mm, opisthotonus, retrocollis, fever • Phase 3: after 1st week; hypertonia • Kernicterus** • 1st postnatal year: hypotonia, delayed motor skills • Later: choreoathetotic cerebral palsy, dental dysplasia, sensorineural hearing loss, cognitive impairment

  14. Biliary atresia • Progressive and destructive inflammatory process that affects the extra and intra-hepatic biliary tree • Presentation** • Typically well-appearing • Jaundice 1-2 weeks after birth • Elevated direct bilirubin with mild elevation of total bilirubin (typically <12) • Increase AP or GGT • Imaging** • Abdominal US • HepatobiliaryScintiscanning • Kasai Procedure*

  15. Noon Conference Fever without a source, Dr. Hescock

More Related