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NGR 6304 MODULE 1 JAUNDICE & HYPERBILIRUBINEMIA 2025|QS &AS|A+ GRADED
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Bilirubin The substance produced by the breakdown of hemoglobin from RBCs Indirect bilirubin Unconjugated, lipid-soluble bilirubin that is bound to albumin and transported to the liver for conjugation and clearance. Direct bilirubin Conjugated, water-soluble bilirubin that is excreted from the liver as bile, into urine and feces Jaundice (icterus)
Yellowish discoloration of the skin, sclera, and mucous membranes as a result of hyperbilirubinemia (Visible when bilirubin reaches 5- mg/dL) Physiologic jaundice definition Non-pathologic, elevated unconjugated bilirubin occurring AFTER 24 hrs of life, peaking around 3-5 days after life, occurs in 60% of infants, they often are well otherwise and it resolves without complications. Causes of physiologic jaundice -Transition from fetal life (newborn must conjugate indirect bilirubin to direct bilirubin) -Increased bilirubin production from increased RBC levels -Shortened lifespan of fetal RBCs -Immature liver What are some ways to prevent physiologic jaundice? -Screen for ABO & Rh incompatibility
How does jaundice progress in the term of bilirubin level and location? It appears in a cephalocaudal manner: -face only: 4-8 mg/dL -upper trunk: 5-12 mg/dL -lower trunk: 8-16 mg/dL -soles of feet: >15 mg/dL When should a bilirubin screening test be done on a newborn? It should be done at 24-48 hrs after birth, BEFORE discharge with either a transcutaneous bilirubin (TcB) (NOT reliable if an infant has received phototherapy) or a total serum bilirubin (TSB), done with a heel stick. **Other labs: hgb, retic ct, blood type, Coombs test, G6PD At what level should a TcB be followed by a TSB? If TcB is high, 3 mg/dL of the threshhold, or if TcB is ≥15 mg/dL What are the main recommendations for treatment of jaundice?
Breastmilk jaundice -LATE-ONSET jaundice which occurs between 5-7 days of age and persists for 3-12 weeks causing indirect hyperbilirubinemia BEYOND the first week of life. -Caused by: a factor in human milk that promotes an increase in intestinal absorption. -Usually resolves, but will be closely monitored while pathologic causes are ruled out. Bilirubin Encephalopathy CNS complications from excess bilirubin levels When to be concerned: -Cord blood bili of 4 mg/dL -Jaundice within 24 hrs -Bili levels increasing > 5 mg/dL over 24 hrs -Bili levels > 15 mg/dL in term, 10 mg/dL in preterm -Jaundice lasting > 10 days in term, > 21 days in preterm
Kernicterus A chronic form of bilirubin encephalopathy
