breastfeeding 30% 1960s 70% today strong association b/w breastfeeding and hyperbilirubinemia ...

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