Neonatal Critical Care (Cober)
Most common clinical diagnosis in
neonates
Increase in unconjugated (indirect) biliru-
bin (not able to convert it to conjugated
to secrete it)
Assessed via:
-Total serum blood (TSB): gold standard
-Transcutaneous bilirubin (TcB) level
-Collect levels prior to discharge and plot
on hour-specific bilirubin nomogram (in-
cludes risk factors) if they fall above the
normal line you must treat them.
What is neonatal jaundice?
Bilirubin is a potent neurotoxin at high
levels (bilirubin is bound to albumin) -->
leading to kernicterus
Causes:
-Increased bilirubin production: Break-
down of the heme of hemoglobin from
bruising during birth.
-Delayed bilirubin elimination: immature
livers and intestines don't eliminate well
-Unique neonatal phenomenon of en-
terohepatic reabsorption of bilirubin
Acute clinical manifestations (very rare):
• Progressive changes in infant's cry pat-
tern
• Nystagmus
• Progressive changes in muscle tone
• Apnea
• Seizures
• Behavioral changes
If unmonitored or with delayed treatment,
, Neonatal Critical Care (Cober)
irreversible posticteric sequelae, known
as kernicterus, may result:
- Movement disorders of dystonia,
athetosis, and choreoathetosis
- Sensorineural hearing loss
How does neonatal jaundice cause neu-
- Oculomotor abnormalities of strabis-
rologic injury?
mus
-Gaze palsies (esp., upgaze)
One of most easily preventable forms of
neonatal brain damage
1. Increased bilirubin production:
-Rh/ABO incompatibilities: Rh- mom with
Rh+ baby--> high bilirubin because the
baby has been destroying its RBCs. If
the mom has had a lot of exposure to
different blood types she might have an-
tibodies to different ABO types.
-RBC enzyme defects: G6PD deficiency
(rare)
What are the predisposing risk factors for
-Sepsis
neonatal jaundice?
-Extravasated blood from bruising
2. Increased enterohepatic circulation:
-Prematurity
-Starvation
-Decreased GI activity
-Delayed bacterial colonization of gut
3. Decreased elimination: Various genet-
ic disorders
Prevention remains key strategy
Phototherapy: skin can convert bilirubin.
Need to make sure they are hydrated.
Most common clinical diagnosis in
neonates
Increase in unconjugated (indirect) biliru-
bin (not able to convert it to conjugated
to secrete it)
Assessed via:
-Total serum blood (TSB): gold standard
-Transcutaneous bilirubin (TcB) level
-Collect levels prior to discharge and plot
on hour-specific bilirubin nomogram (in-
cludes risk factors) if they fall above the
normal line you must treat them.
What is neonatal jaundice?
Bilirubin is a potent neurotoxin at high
levels (bilirubin is bound to albumin) -->
leading to kernicterus
Causes:
-Increased bilirubin production: Break-
down of the heme of hemoglobin from
bruising during birth.
-Delayed bilirubin elimination: immature
livers and intestines don't eliminate well
-Unique neonatal phenomenon of en-
terohepatic reabsorption of bilirubin
Acute clinical manifestations (very rare):
• Progressive changes in infant's cry pat-
tern
• Nystagmus
• Progressive changes in muscle tone
• Apnea
• Seizures
• Behavioral changes
If unmonitored or with delayed treatment,
, Neonatal Critical Care (Cober)
irreversible posticteric sequelae, known
as kernicterus, may result:
- Movement disorders of dystonia,
athetosis, and choreoathetosis
- Sensorineural hearing loss
How does neonatal jaundice cause neu-
- Oculomotor abnormalities of strabis-
rologic injury?
mus
-Gaze palsies (esp., upgaze)
One of most easily preventable forms of
neonatal brain damage
1. Increased bilirubin production:
-Rh/ABO incompatibilities: Rh- mom with
Rh+ baby--> high bilirubin because the
baby has been destroying its RBCs. If
the mom has had a lot of exposure to
different blood types she might have an-
tibodies to different ABO types.
-RBC enzyme defects: G6PD deficiency
(rare)
What are the predisposing risk factors for
-Sepsis
neonatal jaundice?
-Extravasated blood from bruising
2. Increased enterohepatic circulation:
-Prematurity
-Starvation
-Decreased GI activity
-Delayed bacterial colonization of gut
3. Decreased elimination: Various genet-
ic disorders
Prevention remains key strategy
Phototherapy: skin can convert bilirubin.
Need to make sure they are hydrated.
