18 Questions
What is the primary cause of yellow staining of nuclear centers of the brain in neonates?
Indirect bilirubin
What is the primary function of surfactant in the lungs?
Reduces surface tension of fluids
What is the most common cause of Respiratory Distress Syndrome (RDS) in newborns?
Premature birth
What is the consequence of unequal alveolar expansion and collapse in RDS?
Respiratory failure
What is the critical period for the final unfolding of the alveolar septa in fetal development?
Last trimester
What is the incidence of RDS in newborns?
7%
What is the primary goal of phototherapy in treating neonatal jaundice?
To decrease total serum bilirubin (TSB) by 4-5 mg/dL or < 15 mg/dL
What is a common complication of exchange transfusion?
Infection
What is the primary mechanism of phototherapy in treating neonatal jaundice?
Converting bilirubin to a water-soluble form
What is the significance of a bilirubin level > 5 mg/dL in a physical exam?
It signifies a higher risk of neurotoxicity
What is the purpose of exchange transfusion in treating neonatal jaundice?
To correct anemia and remove bilirubin
What is the indicators of a higher bilirubin level in neonatal jaundice?
Caudal progression of jaundice
What percentage of term newborns have clinical jaundice?
25% to 50%
What is the primary source of bilirubin production in newborns?
Haemoglobin breakdown
What is the characteristic of physiological jaundice in term babies?
Peak in the fourth or fifth day, not exceeding 12 mg/dl
What is the feature of pathological jaundice in the first 24 hours?
Jaundice in the first 24 hours
What is the classification of jaundice based on the source of bilirubin production?
Hemolytic and non-hemolytic
What is the factor that contributes to the development of physiological jaundice in newborns?
Immature hepatic uptake and conjugation
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
This quiz covers the basics of jaundice in newborns, including its causes, symptoms, and diagnosis. Learn about the role of bilirubin in jaundice and how it affects newborns. Test your knowledge and understanding of neonatal disorders.
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