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Questions and Answers
What is the primary reason for increased bilirubin levels in breastfeeding jaundice?
What is the primary reason for increased bilirubin levels in breastfeeding jaundice?
Breastmilk jaundice typically lasts less than 3 weeks.
Breastmilk jaundice typically lasts less than 3 weeks.
False (B)
What management strategy is recommended for breastfeeding jaundice?
What management strategy is recommended for breastfeeding jaundice?
Continue breastfeeding
Phototherapy for jaundice requires protection of the ______ and gonads.
Phototherapy for jaundice requires protection of the ______ and gonads.
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Match the following features or terms with their descriptions:
Match the following features or terms with their descriptions:
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Which reflex is typically developed by 37 weeks of gestation?
Which reflex is typically developed by 37 weeks of gestation?
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The rooting reflex is less prominent after the first month of life.
The rooting reflex is less prominent after the first month of life.
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What is the primary function of the rooting reflex in newborns?
What is the primary function of the rooting reflex in newborns?
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The ______ reflex involves involuntary grasping of objects and lasts for about 2-3 months after birth.
The ______ reflex involves involuntary grasping of objects and lasts for about 2-3 months after birth.
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Match the following neonatal reflexes with their duration after birth:
Match the following neonatal reflexes with their duration after birth:
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What condition is characterized by GIR requirements exceeding 12 mg/kg/min or hypoglycemia persisting for more than 7 days after treatment begins?
What condition is characterized by GIR requirements exceeding 12 mg/kg/min or hypoglycemia persisting for more than 7 days after treatment begins?
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Asymmetric septal hypertrophy in an infant resolves after birth when insulin levels decrease.
Asymmetric septal hypertrophy in an infant resolves after birth when insulin levels decrease.
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Name one major cause of resistant hypoglycemia.
Name one major cause of resistant hypoglycemia.
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Maternal hyperglycemia leads to increased _____ in the fetus, resulting in anabolism and greater growth.
Maternal hyperglycemia leads to increased _____ in the fetus, resulting in anabolism and greater growth.
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Match the following conditions with their associated effects:
Match the following conditions with their associated effects:
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Which congenital heart defect is the most common in neonates?
Which congenital heart defect is the most common in neonates?
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Hypoglycemia is the most common cause of seizures in neonates.
Hypoglycemia is the most common cause of seizures in neonates.
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Name a metabolic abnormality associated with congenital malformations in neonates.
Name a metabolic abnormality associated with congenital malformations in neonates.
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Mothers with uncontrolled diabetes can lead to __________ congenital anomalies in neonates.
Mothers with uncontrolled diabetes can lead to __________ congenital anomalies in neonates.
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Match the following congenital defects with their corresponding categories:
Match the following congenital defects with their corresponding categories:
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What is the minimum irradiance level required for effective phototherapy in neonatal jaundice?
What is the minimum irradiance level required for effective phototherapy in neonatal jaundice?
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Photoisomerisation involves the transformation of bilirubin to lumirubin due to light exposure.
Photoisomerisation involves the transformation of bilirubin to lumirubin due to light exposure.
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What condition is indicated for double volume exchange transfusion (DVET)?
What condition is indicated for double volume exchange transfusion (DVET)?
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The minimum distance from the light source during phototherapy is ______ cm.
The minimum distance from the light source during phototherapy is ______ cm.
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Match the following treatments or terms in relation to neonatal jaundice:
Match the following treatments or terms in relation to neonatal jaundice:
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What is the main concern associated with neonatal hypoglycemia?
What is the main concern associated with neonatal hypoglycemia?
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Neonatal hypoglycemia can lead to serious neurological issues if not treated promptly.
Neonatal hypoglycemia can lead to serious neurological issues if not treated promptly.
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What is a common method to assess blood glucose levels in newborns?
What is a common method to assess blood glucose levels in newborns?
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A newborn with low blood glucose is often treated with ______ to raise blood sugar levels.
A newborn with low blood glucose is often treated with ______ to raise blood sugar levels.
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Match the following terms with their corresponding descriptions:
Match the following terms with their corresponding descriptions:
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Which classification indicates severe hypothermia?
Which classification indicates severe hypothermia?
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Kangaroo mother care should be stopped once the baby attains a weight of less than 2.5 kg.
Kangaroo mother care should be stopped once the baby attains a weight of less than 2.5 kg.
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What is the preferred operating mode for an overhead radiant warmer?
What is the preferred operating mode for an overhead radiant warmer?
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In a hemodynamically unstable baby, place them in the ______.
In a hemodynamically unstable baby, place them in the ______.
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Match the following temperature classifications with their categories:
Match the following temperature classifications with their categories:
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What is the reliability of transcutaneous bilirubinometry (TB) in evaluating bilirubin levels in preterm babies?
What is the reliability of transcutaneous bilirubinometry (TB) in evaluating bilirubin levels in preterm babies?
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Physiological jaundice only involves unconjugated bilirubin.
Physiological jaundice only involves unconjugated bilirubin.
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Name one common hemolytic disorder that can cause pathological jaundice.
Name one common hemolytic disorder that can cause pathological jaundice.
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Pathological jaundice is characterized by bilirubin levels exceeding ______ mg/dL.
Pathological jaundice is characterized by bilirubin levels exceeding ______ mg/dL.
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Match the following types of bilirubin increase with their causes:
Match the following types of bilirubin increase with their causes:
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What is the normal temperature range for neonates?
What is the normal temperature range for neonates?
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The head is the largest site for heat loss in neonates.
The head is the largest site for heat loss in neonates.
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What is a primary source of heat production in neonates?
What is a primary source of heat production in neonates?
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The major mechanism of heat loss in neonates is ______.
The major mechanism of heat loss in neonates is ______.
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Match the following sources of heat production in neonates with their descriptions:
Match the following sources of heat production in neonates with their descriptions:
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At what age does the symmetric tonic neck reflex typically disappear?
At what age does the symmetric tonic neck reflex typically disappear?
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The parachute reflex does not disappear after it develops.
The parachute reflex does not disappear after it develops.
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Name one potential cause of an absent Moro reflex in a term newborn.
Name one potential cause of an absent Moro reflex in a term newborn.
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Hypoxic ischemic encephalopathy is characterized by impaired gas exchange leading to ______ dysfunction.
Hypoxic ischemic encephalopathy is characterized by impaired gas exchange leading to ______ dysfunction.
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Match the following reflexes with their methods to elicit them:
Match the following reflexes with their methods to elicit them:
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Study Notes
Breastfeeding Jaundice
- Onset: Within 5-7 days of age (up to 1 week)
- Causes: Decreased breast milk intake, leading to decreased enterohepatic circulation of bilirubin.
-
Clinical Features:
- Excessive weight loss (>10% of body weight)
- Increased frequency of breastfeedings
-
Breastmilk Jaundice:
- Jaundice lasting more than 3 weeks
- Diagnosis of exclusion
- Cause: Beta-glucuronidase in milk leads to decreased conjugation of bilirubin and increased unconjugated bilirubin levels.
- Management: Continue breastfeeding, transient and self-resolving
Treatment of Jaundice
- Normogram: Used to determine the course of treatment for jaundice
-
Phototherapy:
- Uses blue-green LED light (460-490 nm)
- Requires protection of eyes and gonads
Neonatal Reflexes
-
Palmar Grasp
- Involuntary palmar grasp
- Onset: 28 weeks gestation
- Fully developed by: 32 weeks gestation
- Disappears by: 2-3 months
-
Rooting Reflex:
- Stimulus near mouth, face turns ipsilaterally
- Onset: 28-32 weeks gestation
- Fully developed by: 34-36 weeks gestation
- Less prominent after 1 month
-
Moro Reflex:
- Extension and abduction of hands, flexion and adduction of hands, neck turned to one side
- Onset: 28-32 weeks gestation
- Fully developed by: 37 weeks gestation
- Disappears by: 5-6 months
-
Asymmetric Tonic Neck Reflex:
- Ipsilateral extension, contralateral flexion
- Onset: 35 weeks gestation
- Fully developed by: 1 month after birth
- Disappears by: 6-7 months
Neonatal Hypothermia and Neonatal Hypoglycemia
Resistant Hypoglycemia
- Definition: GIR requirements exceed >12 mg/kg/min or hypoglycemia persists for >7 days after starting treatment
-
Major Causes:
- Hypopituitarism: Due to decreased ACTH
- Metabolic disorders: Glycogen storage disorder, galactosemia
- Nesidioblastosis: β- islet cell hyperplasia of pancreas → Congenital hypoglycemia
-
Management:
- Stimulate gluconeogenesis: Hydrocortisone, glucagon
- ↓ insulin production: Diazoxide, octreotide
- Note: Do not use diazoxide and glucagon in SGA babies.
Infant of Diabetic Mother (IDM)
-
Pedersen's Hypothesis: maternal hyperglycemia (↑ glucose)
- ↑ glucose →↑ insulin in fetus → Anabolism &↑ growth → LGA baby
-
Effects of ↑ insulin:
- Asymmetric septal hypertrophy
- Inactivation of surfactant
- Lazy left colon syndrome
-
Side effects in LGA baby:
- ↑ O₂ requirement → ↑ RBC production/polycythemia → Hyperviscocity → Thromboembolism
Neonatology Congenital Malformations
-
Etiology:
- Mothers with uncontrolled diabetes
- Hyperglycemia in the first trimester (embryogenesis) leading to congenital anomalies
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Defects Seen:
-
Cardiac Defects:
- Most common: Ventricular Septal Defect (VSD)
- More severe: Transposition of great arteries
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Central Nervous System (CNS) Defects:
- Most common: Neural tube defects (NTD)
- More severe: Caudal regression syndrome (lumbosacral agenesis), poorly developed lower limbs
-
Cardiac Defects:
-
Metabolic Abnormalities:
-
Hypocalcemia and Hypomagnesemia:
- Increased insulin levels interfere with parathyroid hormone (PTH) release, leading to functional hypoparathyroidism
- Low calcium levels (Ca2+<8Ca^{2+} < 8Ca2+<8 mg/dL)
- Low magnesium levels (Mg2+<1.5Mg^{2+} < 1.5Mg2+<1.5 mg/dL)
- Hypoglycemia: Most common cause of seizure (hypoglycemia > hypocalcemia)
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Hypocalcemia and Hypomagnesemia:
Neonatal Jaundice
Mechanism
- Structural isomerism: Bilirubin structure changed. Bilirubin → Lumirubin → Excreted.
- Photoisomerisation: Light → Bilirubin isomers formed.
- Photooxidation
Treatment
- Minimum Irradiance: 30 microwatt/cm²/nm
- Minimum Distance from Light Source: 30-45 cm
- Termination of Phototherapy: At least a consequent values within the normal curves on normogram.
- C/1: Conjugated bilirubin (Brown pigment formation → Bronze baby syndrome).
Double Volume Exchange Transfusion (DVET)
- Indications: Very high bilirubin level (Abnormal in normogram). Rh isoimmunization with Cord blood bilirubin >5 mg/dL or Cord blood hemoglobin < 10 g/dL.
Neonatal Hypoglycemia
- Blood glucose level below 40 mg/dL is considered hypoglycemia.
Neonatal Hypothermia and Neonatal Hypoglycemia
Temperature Regulation
- Normal temperature: 36.5 - 37.5°C
- Site: Roof of dry axilla
- Instrument: Electronic thermometer
Mechanism of Heat Loss
-
Types:
- Major mechanism: Radiation, convection, conduction, evaporation
- Via sweat
- Heat loss major site: Head (largest surface area)
Sources of Heat Production
- Physical activity
-
Brown fat: Non shivering thermogenesis in early months of life.
- Locations: Nape of neck (most common), inter scapular region, peri renal region.
- Mechanism: Uncoupling of oxidative phosphorylation.
Postnatal Reflexes
-
Symmetric tonic neck reflex:
- Baby held from below in prone position: Extension of neck → B/L UL extension + LL flexion, Flexion of neck → B/L UL flexion + LL extension
- Appearance: 4-6 months
- Disappearance: 8-12 months
-
Parachute reflex:
- Baby tilted forward (mimic falling). Baby held in ventral suspension in prone position: Extension of arms
- Appearance: 7-8 months
- Disappearance: Does not disappear
-
Landau reflex:
- Flexion of neck → B/L LL flexion , Extension of neck → B/L LL extension
- Appearance: 3 months
- Disappearance: 59 months
Moro Reflex - Abnormalities
-
Absent Response (Term newborn):
- Due to structural/functional disorders in the brain
- Causes: Brain anomalies (anencephaly), decreased brain function (hypoxic ischemic encephalopathy (HIE))
-
Abnormal Moro Reflex:
- Sluggish response: Due to hypotonia (Metabolic disorders, Down syndrome, spinal muscular atrophy)
- Unilateral response: Due to pathology in limbs (Nerve injury - brachial plexus injury, Klumpke's paralysis, bone injury - fracture/dislocation)
Birth Asphyxia and HIE (Hypoxic Ischemic Encephalopathy)
- AKA perinatal asphyxia/perinatal depression
- Impaired gas exchange (hypoxia) + complications
- Brain: HIE (Hypoxic Ischemic Encephalopathy)
- Multiorgan dysfunction
- Lactic acidosis (D/t ↑ anaerobic metabolism)
HYPOTHERMIA
-
Classification:
- Cold stress: 36.4°C - 36°C
- Moderate hypothermia: 36-34°C
- Severe hypothermia: 37.5°C
PREVENTION OF HYPOTHERMIA
-
Hemodynamically stable baby:
- Cover the body from head to toe
-
Kangaroo mother care (KMC):
- In LBW or preterm babies
- Nutrition: Breastfeed
- Duration: As long as possible
- Mother can take naps during KMC in semi-recumbent position (30° elevation)
- Avoid 1-hour sessions; repeated handling of the baby → Stress
- Stop KMC once baby attains ≥ 2.5 kg or at 37 weeks
-
Hemodynamically unstable baby:
- Place in NICU
-
Overhead radiant warmer:
- Open source
- Heat transfer by radiation
- Operating modes (manual, auto/servo)
- Incubator: Closed/covered source of heat
Neonatal Jaundice
Transcutaneous Bilirubinometry (TB)
- Better than visual assessment
- Unreliable in:
- High bilirubin levels (>15 mg/dL)
- Preterm babies
Types Of Jaundice
FeaturePhysiological Jaundice (Common)Pathological Jaundice (Less Common)Bilirubin TypeAlways conjugated, mildly elevatedCan be conjugated or unconjugated, largely elevated (>15 mg/dL)Bilirubin Values (TSB)>5 mg/dLRate of Increase (TSB)1 mg/dL or >20% of TSB.
Causes Of Jaundice
-
Pathological Jaundice:
-
↑ unconjugated bilirubin:
- Hemolytic disorders (e.g., Hereditary spherocytosis, G-6-PD deficiency)
- Blood group incompatibility (e.g., ABO/Rh incompatibility)
-
↓ UDGPT enzyme activity:
- Sepsis, hypothyroidism
- Inherited defect of UDPGT enzyme (Criggler-Najjar syndrome)
- Two types:
- Type I: Complete absence of enzyme (Severe)
- Type II: Partial absence of enzyme
- Two types:
- Extravasation of blood: Cephalhematoma
-
↑ conjugated bilirubin:
- Biliary atresia: Obstruction of bile flow to intestine
-
↑ unconjugated bilirubin:
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Description
This quiz focuses on the causes, clinical features, and management of breastfeeding jaundice in neonates. It covers important topics such as the effects of breast milk intake, the role of phototherapy, and neonatal reflexes related to jaundice treatment. Test your knowledge of these essential concepts in newborn care.
