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# Mometrix ## Treatment Includes: * Preventive suctioning of the oropharynx as soon as the head is delivered. * Tracheal/bronchial suctioning to remove meconium plugs as indicated. * Umbilical (arterial and venous) monitoring of ABGs. * Intravenous fluids. * Intubation, oxygen, assisted ventilatio...

# Mometrix ## Treatment Includes: * Preventive suctioning of the oropharynx as soon as the head is delivered. * Tracheal/bronchial suctioning to remove meconium plugs as indicated. * Umbilical (arterial and venous) monitoring of ABGs. * Intravenous fluids. * Intubation, oxygen, assisted ventilation (CPAP at 5-7 cm H2O), and suctioning of the trachea for infants with respiratory distress (weak respirations, bradycardia, hypotonia). * EMCO as indicated. * Nitric Oxide if PPHN occurs. * Antibiotic prophylaxis to prevent pneumonia. ## Neonatal Jaundice ### Hyperbilirubinemia-Physiologic Hyperbilirubinemia, excess of bilirubin in the blood, is characterized by jaundice. Hyperbilirubinemia is evaluated according to the levels of direct (conjugated) bilirubin and/or indirect (unconjugated) bilirubin: * **Direct/conjugated bilirubin** levels increase with blockage of bile ducts, hepatitis or other liver damage, including drug reaction. * **Indirect/unconjugated bilirubin** levels increase with anemias (such as hemolytic disorders) and transfusion reactions. Basic types of hyperbilirubinemia are physiologic, hemolytic, breast-feeding associated, and breast milk jaundice: * **Physiologic** - Common in newborns and usually benign, resulting from immature hepatic function and increased RBC hemolysis. Infants have larger red blood cells with a shorter life than adults, leading to more RBC destruction and resulting in an increased load of serum bilirubin, which the liver of the newborn cannot handle. Premature infants have an even greater physiologic jaundice as their RBCs live even shorter lives than the term infant's. Onset is usually within 24-48 hours, peaking in 72 hours for full term or 5 days for preterm infants and declining within a week. Phototherapy is the indicated treatment for total serum bilirubin ≥18 mg/dL. * **Hemolytic** - Caused by blood/antigen (Rh) incompatibility with onset in first 24 hours. Preventive treatment is RhoGAM® prenatally or post-natal exchange transfusion. This type of hyperbilirubinemia may also result from ABO incompatibility, but rarely requires treatment other than phototherapy. * **Breast-feeding associated** - Relates to inadequate calories during early breastfeeding with onset on 2-3 days. This slows the excretion of stool and allows bilirubin levels to rise. More frequent feeding with caloric supplements is usually sufficient, but phototherapy may be used for bilirubin 18-20 mg/dl. * **Breast milk jaundice** - May result from breast milk breaking down bilirubin and its being reabsorbed in the gut. Characterized by less frequent stools and onset in 4-5th day, peaking in 10-15 days, but jaundice may persist for a number of weeks. Treatment involves discontinuing breastfeeding for 24 hours.