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Questions and Answers
What is the primary cause of yellow staining of nuclear centers of the brain in neonates?
What is the primary cause of yellow staining of nuclear centers of the brain in neonates?
- Direct bilirubin
- Hemoglobin
- Biliverdin
- Indirect bilirubin (correct)
What is the primary function of surfactant in the lungs?
What is the primary function of surfactant in the lungs?
- Regulates blood flow
- Increases surface tension of fluids
- Reduces surface tension of fluids (correct)
- Maintains lung pressure
What is the most common cause of Respiratory Distress Syndrome (RDS) in newborns?
What is the most common cause of Respiratory Distress Syndrome (RDS) in newborns?
- Pneumonia
- Premature birth (correct)
- Hypoglycemia
- Sepsis
What is the consequence of unequal alveolar expansion and collapse in RDS?
What is the consequence of unequal alveolar expansion and collapse in RDS?
What is the critical period for the final unfolding of the alveolar septa in fetal development?
What is the critical period for the final unfolding of the alveolar septa in fetal development?
What is the incidence of RDS in newborns?
What is the incidence of RDS in newborns?
What is the primary goal of phototherapy in treating neonatal jaundice?
What is the primary goal of phototherapy in treating neonatal jaundice?
What is a common complication of exchange transfusion?
What is a common complication of exchange transfusion?
What is the primary mechanism of phototherapy in treating neonatal jaundice?
What is the primary mechanism of phototherapy in treating neonatal jaundice?
What is the significance of a bilirubin level > 5 mg/dL in a physical exam?
What is the significance of a bilirubin level > 5 mg/dL in a physical exam?
What is the purpose of exchange transfusion in treating neonatal jaundice?
What is the purpose of exchange transfusion in treating neonatal jaundice?
What is the indicators of a higher bilirubin level in neonatal jaundice?
What is the indicators of a higher bilirubin level in neonatal jaundice?
What percentage of term newborns have clinical jaundice?
What percentage of term newborns have clinical jaundice?
What is the primary source of bilirubin production in newborns?
What is the primary source of bilirubin production in newborns?
What is the characteristic of physiological jaundice in term babies?
What is the characteristic of physiological jaundice in term babies?
What is the feature of pathological jaundice in the first 24 hours?
What is the feature of pathological jaundice in the first 24 hours?
What is the classification of jaundice based on the source of bilirubin production?
What is the classification of jaundice based on the source of bilirubin production?
What is the factor that contributes to the development of physiological jaundice in newborns?
What is the factor that contributes to the development of physiological jaundice in newborns?
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Study Notes
Kernicterus
- Caused by high levels of indirect bilirubin
- Leads to neural loss, poor feeding, lethargy, fits, rigidity, spasticity, deafness, and respiratory distress
Respiratory Distress Syndrome (RDS)
- Affects 7% of newborns, potentially life-threatening
- Caused by surfactant deficiency and physiologic immaturity of the thorax
- Common in premature infants
- Causes: sepsis, exposure to cold, airway obstruction, metabolic acidosis, acute blood loss, drugs, pneumonia, hypoglycemia, and cardiac defects
- Pathophysiology: preterm infants' lungs are not fully mature, leading to underdeveloped and un-inflatable alveoli
Neonatal Jaundice
- Yellowish discoloration of skin and mucous membranes due to increased serum bilirubin (hyperbilirubinemia)
- Bilirubin is produced as a breakdown product of hemoglobin
- Physiological jaundice:
- Appears in 25-50% of term newborns
- Starts after 24 hours, peaks on the 4th or 5th day (<12 mg/dl in term babies, <15 mg/dl in premature)
- Clears in a week in term and two weeks in premature babies
- Pathological jaundice:
- Starts within the first 24 hours
- Rapidly rising total serum bilirubin (>5 mg/dL per day)
- TSB > 17 mg/dL
- Categories:
- Increased bilirubin load
- Decreased conjugation
- Impaired bilirubin excretion
- Causes:
- Hemolytic disease (e.g., Rh incompatibility, ABO incompatibility)
- Non-hemolytic disease (e.g., G6PD deficiency, extravascular sources)
- Biliary obstruction (e.g., biliary atresia, Rotor's and Dubin-Johnson syndromes)
- Infection (sepsis)
- Metabolic disorders
- Chromosomal abnormalities
Diagnosis and Evaluation
- Physical exam: bilirubin > 5 mg/dL, milder jaundice on face and upper thorax
- Laboratory tests: blood and transcutaneous bilirubin levels
- Depends on serum bilirubin level and age (hours) of the baby after delivery
Therapeutic Management
- Phototherapy:
- Converts bilirubin to a water-soluble form that is easily excreted
- Forms: fluorescent lighting, fiberoptic blankets
- Goal: decrease TSB by 4-5 mg/dL or < 15 mg/dL
- Complications: retinal damage, nasal obstruction, mild diarrhea, dehydration, bronzed baby syndrome
- Exchange transfusion:
- Removes bilirubin and antibodies from circulation, corrects anemia
- Most beneficial to infants with hemolysis, generally used after intensive phototherapy
- Indicated when bilirubin reaches toxic levels
- Removes bilirubin, antibodies, and corrects anemia
- Complications: infection, cardiac failure, acidosis, electrolytes imbalance
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