monkeycros.blogg.se - Pathological neonatal jaundice

#PATHOLOGICAL NEONATAL JAUNDICE SKIN#
#PATHOLOGICAL NEONATAL JAUNDICE FULL#

The underlying cause should be treated if possible (i.e. Breast feeding does not need to be discontinued.

consider abdominal Ultrasound if conjugated hyperbilirubinemia.

Liver enzymes (AST, ALT, GGT, Alk Phos) and liver function tests (PT, PTT, albumin, ammonia) if conjugated hyperbilirubinemia.

Other red cell enzyme studies if hemolysis remains undefined.

G6PD (Glucose-6-Phosphate Dehydrogenase) screen (especially if male and of Asian or Middle Eastern ethnicity).

Peripheral blood smear (for RBC morphology).

CBC (mainly for Hb and Hct but also WBC as a non-specific marker of infection).

Serum bilirubin: conjugated and unconjugated.

Cranial nerves, tone, gross motor movements, quality of the cry, and primitive reflexes (Moro, grasps, tonic-neck, step).

Abdomen: Is the abdomen distended? Is there caput medusa (evidence of portal hypertension)? Are there any masses? Check for hepatomegaly and splenomegaly.

If the neonate is in heart failure, there may be respiratory signs.

Respiratory: Respiration rate and rhythm and oxygen saturation.

Severe haemolytic processes can result in heart failure.

Cardiovascular: Heart rate, pulse volume, blood pressure, apex location, perfusion.

Remember that jaundice first becomes clinically apparent at the cephalic end of the body, and only progresses caudally as serum levels increase. HEENT: Is there pallor? Sclerae and mucous membranes should be closely inspected for jaundice.Depending on the newborn’s age, excessive weight loss or insufficient weight gain may point to dehydration. Growth Parameters: Obtain length, weight and head circumference and compare to measurements taken at birth.In hemolytic states, there can be an increase in heart rate and respiration rate as well as poor perfusion.

#PATHOLOGICAL NEONATAL JAUNDICE FULL#

Vitals: If febrile, the newborn will require a full septic work-up.General: Does the child look well or unwell? You may be able to observe the child feeding – is the baby having difficulty feeding? Is the baby consolable?.The jaundiced neonate requires a full physical examination with emphasis on the following:.Congenital abnormality of the biliary tree.Conjugation defects (Crigler-Najar, Gilberts).Hemoglobinopathy (sickle cell, thalessemia).

Red cell enzyme or membrane defect (G6PD, Spherocytosis, elliptocytosis, phosphokinase deficiency).

Isoimmunization (ABO incompatibility, Rh Disease, other).

There are numerous causes of jaundice in a neonate, organized into those which result in an unconjugated (indirect) hyperbilirubinemia or a conjugated (direct) hyperbilirubinemia.

Previous siblings with neonatal jaundice.

Delayed cord clamping (could indicate polycythemia).

Gender & ethnicity? (Males, Asians, and Blacks have some increased risk.

General activity: irritable? lethargic?.

Consistency and colour of stool?(pale stool implies poor bili excretion).

Number of wet diapers per day? (Indicator of hydration status).

Current weight compared to birth weight.

#PATHOLOGICAL NEONATAL JAUNDICE SKIN#

Onset and progression of jaundiced skin.Jaundice is visible when serum bilirubin levels are greater than 85-120 umol/L and tends to be more severe or prolonged with prematurity, acidosis, hypoalbuminemia and dehydration. The conjugation process takes place in the liver, and produces a water-soluble conjugated bilirubin, which is ready to be excreted from the body. Unconjugated bilirubin is not very soluble in aqueous solution, and therefore needs to be bound to albumin in the blood. Conjugated / direct hyperbilirubinemia – always pathologicīilirubin is a bile pigment that is formed from the breakdown of heme, mainly as a product of red blood cell degradation.Unconjugated / indirect hyperbilirubinemia – can be physiologic or pathologic.There are two main types of hyperbilirubinemia: Hyperbilirubinemia at high levels can however have toxic effects on the body, such as kernicterus. Jaundice is not a disease by itself, but rather, a sign that results from hyperbilirubinemia, the excessive accumulation of bilirubin in the blood. Jaundice is common in the neonatal period, affecting 50-60% of newborns. The term “jaundice” comes from the root jaune, the French word for “yellow”. Click for pdf: Neonatal Jaundice Background