Neonatal+Jaundice

=**Important Concepts, Management Approach, and Materials -**= > - higher hemoglobin (polycythemia, cephalohematoma, excessive bruising, vacuum delivery). > - abnormal liver function (sepsis, acidosis, primary hepatobiliary disorders). > - delayed excretion on bilirubin in stool (breast milk, delayed feeding, or poor feeding). > - Magnesium exposed babies, who are hypotonic and poor feeders. > - Blood type incompatibility (ABO, Rh) > - Other hemolytic process (congenital spherocytosis, G6PD deficiency)
 * Important Concepts -**
 * Newborns get jaundiced because they are born with higher hemoglobin (up to the 60’s) and their immature liver is slow to handle the hemoglobin breakdown products (bilirubin).
 * Breastfed babies have higher bilirubin levels than bottle-fed babies.
 * Bilirubin is often higher in babies who have:


 * Management Approach -**
 * What’s the serum bilirubin level? Or get a serum bilirubin if the bili-meter is >10.
 * Is there any reason to suspect sepsis? What’s the GBS status of mom? Did she have chorioamnionitis?
 * Is this baby NPO? Breastfeeding? Feeding poorly in general?
 * Is this baby hemolyzing? What is the mother’s blood type? (Rh neg?, O? – O is more often associated with ABO incompatibility).
 * Use AAP Phototherapy Guideline to determine need for phototherapy (also can use [|www.bilitool.org/])
 * Use Bhutani graph to determine need for f/u bili (> 75th percentile needs follow-up within 24 – 48 hours. Remember: the Bhutani graph is only used for term babies with physiologic jaundice and only for risk stratification.)


 * Labs -**
 * Serum Total bilirubin
 * Check maternal history (GBS, Chorioamnionitis, fever, blood type, Magnesium)
 * Consider: CBCD, CRP, Blood culture if at risk for sepsis
 * Order Type and Coombs on cord blood if mom is blood type O, Rh negative or if bilirubin is approaching treatment range.
 * Get a Reticulocyte count to help determine hemolysis if Coombs positive.
 * Start phototherapy if bilirubin is in treatment range.


 * Review Article -** [|Pediatrics in Review Article]


 * Powerpoint Presentation -** [|Neonataljaundice2010.ppt]


 * Learning Objectives** -

1) Understand the causes for hyperbilirubinemia and assess infants for risk factors for severe hyperbilirubinemia. 2) Evaluate an infant for signs and symptoms of hyperbilirubinemia through physical exam findings and appropriate laboratory exams. 3) Develop a plan for follow-up/treatment as necessary for babies who have an elevated bilirubin.

1) (yes/no) Resident needs to have assessed at least 5 high risk infants (the 48 hour follow-up in the nursery or in clinic)
 * Evaluation -**

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