breastfeeding 30% 1960s 70% today strong association b/w breastfeeding and hyperbilirubinemia ...
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Welcome Applicants!December 9, 2010
PHYSIOLOGIC JAUNDICE
BREASTFEEDING AND JAUNDICE
Breastfeeding 30% 1960s 70% today
Strong association b/w breastfeeding and hyperbilirubinemia
“breastfeeding” vs “breast milk”
APPROPRIATE FOLLOWUP IS ESSENTIAL AAP Recommendations
Any infant discharged <72hrs Followup within 2 days
Infant with risk factors Followup within 24hrs
Delay discharge if necessary Weekends/holidays, etc.
SEVERE HYPERBILIRUBINEMIA
WHEN SHOULD I SEEK AN UNDERLYING CAUSE?
HEMOLYTIC CAUSES
RH ALLOIMMUNIZATION
Mother Rh negative/ infant Rh positive Decreased incidence with use of
Rhogam <1%
ABO HEMOLYTIC DISEASE
Most common immune mediated cause Mother type O, infant A or B
15% of pregnancies 30% of these positive Direct Antibody Test
Anti-A or anti-B antibodies attached to red cells
Jaundice within 24hrs Signs of hemolysis on smear Severe jaundice uncommon
GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY
Most common red cell enzyme defect 4.5 million newborns each year 11-13% of African-American newborns 30% of infants with kernicterus in US
X-linked Increased heme turnover
Overt evidence of hemolysis absent
EVALUATION AND TREATMENT OF PHYSIOLOGIC JAUNDICE
EVALUATING DEGREE OF JAUNDICE
Visual inspection Limited value
Dark skinned individuals Post-phototherapy Difference between 5 and 8 (50 and 95%ile at
24hrs) not perceived by eye Some experts recommend TSB or TcB in all
EVALUATING DEGREE OF JAUNDICE
Transcutaneous Bili Screening tool
“should I worry about this infant?” “should I obtain a TSB?”
Obtain TSB when: TcB >75%ile Post-phototherapy
TREATMENT
Exchange transfusion Removes bili mechanically
Phototherapy Converts bilirubin to soluble products Bypass the liver
INTENSIVE PHOTOTHERAPY
Expect 30-40% decrease in 24hrs Insure that patient maintains hydration
INTENSIVE PHOTOTHERAPY
430-490nm band of at least 30mcW/cm2 per nanometer
Special blue fluorescent tubes Within 10-15cm to patient ! DO NOT place halogen bulbs this close
Delivered to as much surface area as possible Infant in diaper and eye shield only Fiberoptic mattress beneath infant Bililights above infant Line sides of incubator with aluminum foil