Newborn Jaundice.

Newborn Jice - Physiologic answer Jaundice caused by accelerated destruction of fetal RBCs, impaired conjugation of bilirubin, and increased bilirubin reabsorption from the intestinal tract Basis of physiologic jaundice -answer Normal physiological response to being born Factors that may give rise to physiological jaundice -answer Increased bilirubin in liver Defective uptake of bilirubin from plasma Defective conjugation of bilirubin Defect in bilirubin excretion Inadequate hepatic circulation Increased reabsorption of bilirubin from intestine The factor that differentiates pathological jaundice from physiological jaundice -answer Time. Pathologic jaundice appears at birth or within 24 hours of life whereas physiologic jaundice will appear after the first 24 hours Bilirubin serum levels at which yellow will start to appear in the skin and sclera -answer 4 to 6 milligrams per deciliter Icterus -answer Yellow coloring Newborn procedures that will decrease probability of high bilirubin levels -answer Maintain skin temp at greater than or equal to 36.5 degrees Celsius (97.8 degrees Fahrenheit); Monitor amount and characteristics of stool; Encourage early feeding Reason maintaining a normal skin temperature discourages high bilirubin levels -answer Cold stress causes acidosis which decreases available serum albumin-binding sites, weakens albumin-binding powers, and causes elevated unconjugated bilirubin levels Reason it is important to monitor stool to discourage high bilirubin levels -answer Bilirubin is eliminated in feces. Therefore, inadequate stooling may cause reabsorption and recycling of bilirubin. Relationship between early breastfeeding and decreasing high bilirubin levels -answer Colostrum has a laxative effective and increases excretion of meconium and transitional stool Breastfeeding jaundice -answer Jaundice that occurs in the first days of life of breastfed newborns due to inadequate fluid intake and dehydration Ways to prevent breastfeeding jaundice -answer Encouraging frequent breastfeeding (every 2 to 3 hours), avoiding supplementation, and accessing maternal lactation counseling Breast milk jaundice -answer Jaundice related to milk composition promoting increased bilirubin reabsorption from the intestine. Some breast milk may contain several times the normal concentration of certain fatty acids which compete with bilirubin for binding sites on albumin and inhibit conjugation, disrupting the RBC membrane Period in which breast milk jaundice may occur -answer After first week of life and may last several weeks to several months Peak bilirubin levels for breast milk jaundice -answer 5 to 10 milligrams per deciliter Jaundice -answer Yellowing coloration of the skin and sclera of the eyes that develops from the deposit of yellow pigment bilirubin in lipid-fat-containing tissues Normal total bilirubin at birth -answer Less than 3 milligrams per liter Factors for pathologic jaundice diagnosis -answer Exhibit jaundice first 24 hours of life; Total serum bilirubin concentration increase greater than 0.2 milligrams per deciliter per hour; Surpass the 95th percentile on the nomogram for age in hours; Have persistent visible jaundice after 1 week of age for term infants or after 2 weeks for preterm infants Typical bilirubin levels between the third and fifth days of life -answer 5 to 6 milligrams per deciliter Reasons for physiological jaundice -answer Increased RBC mass Shorter RBC lifespan Slower uptake of bilirubin by liver Lack of intestinal bacteria Poorly established hydration from initial breast feeding Lifespan of RBCs in newborns -answer 90 days Primary cause of pathologic hyperbilirubin -answer Hemolytic disease of the newborn Erythroblastosis fetalis (alloimmune hemolytic disease) -answer Maternal antibodies from an Rh negative mother crosses the placenta to an Rh positive fetus, attaching and destroying the fetal RBCs. The fetal system responds by increasing more RBCs Signs and symptoms of erythroblasosis fetalis -answer Jaundice, anemia, compensatory erythropoiesis, and increase in erythroblasts Hydrops fetalis -answer Most severe form of erythroblastosis fetalis in which the maternal anti Rh antibodies attach to the Rh site of the fetal RBC making them susceptible to destruction Essential lab tests for jaundice -answer Coombs' test Serum bilirublin levels (direct and total) Hemoglobin Reticulocyte percentage WBC Positive smear for cellular morphology Coombs' test -answer Tests mother's blood to determine Rh and ABO compatability Indirect Coomb's test -answer Tests infant's blood for antibody-coated (sensitized) Rh-positive RBCs Transcutaneous bilirubin (TcB) -answer Noninvasive method of assessing bilirubin levles Period of time in which phototherapy is most effective -answer 24 to 48 hours of use