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HYPERBILIRUBINEMIA

HYPERBILIRUBINEMIA. Risk Factors TSB in high risk zone Jaundice observed in the first 24 hr Blood group incompatibility or with hemolytic disease (G6PD) Gestational age 35-36wks Previous sibling received phototherapy Cephalhematoma or significant bruising Exclusive breastfeeding

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HYPERBILIRUBINEMIA

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  1. HYPERBILIRUBINEMIA Risk Factors • TSB in high risk zone • Jaundice observed in the first 24 hr • Blood group incompatibility or with hemolytic disease (G6PD) • Gestational age 35-36wks • Previous sibling received phototherapy • Cephalhematoma or significant bruising • Exclusive breastfeeding • East asian race

  2. HYPERBILIRUBINEMIA

  3. HYPERBILIRUBINEMIA Causes Unconjugatedhyperbilirubinemia • Increased production • Decreased conjugation • Competitive blockage of transferase enzyme • Increased enterohepatic recirculation

  4. HYPERBILIRUBINEMIA Causes Conjugated hyperbilirubinemia • Decreased excretion by damaged hepatic parenchymal cells • Diseases of biliary tract

  5. HYPERBILIRUBINEMIA Physiologic Jaundice • Jaundice at 2nd – 3rd day of life • Result of increased bilirubin production from the breakdown of fetal RBC combined with transient limitation in the conjugation due to immature liver • Decreases between 5th - 7th day of life

  6. HYPERBILIRUBINEMIA vs Pathologic Jaundice if: • It appears in the first 24-36 hrs of life • Serum bilirubin is rising at a rate faster than 5mg/dL/24hr • Serum bilirubin is >12mg/dL in FT or 10-14mg/dL in PT • Jaundice persists after 10-14 days of life • Direct reacting bilirubin is >2 mg/dL • With signs of kernicterus

  7. HYPERBILIRUBINEMIA ABO incompatibility • 15% of live births are at risk but manifestations of disease develop in 0.3-2.2% • Mother is type O while baby is A or B • Results from the presence of IgG antibodies against type A or B that can cross the placenta • Dx: ABO incompatibility, positive Coomb’s test

  8. HYPERBILIRUBINEMIA • Low risk >= 38 wks and well Medium risk >= 38wks+risk factors or • High risk 35-37 6/7 + risk factor 35-36 6/7 wks and well

  9. NEONATAL SEPSIS Incidence: 1-4% in preterm, <1% in term infants Risk Factors: • Premature labor • Prolonged rupture of fetal membranesmonoc • Low birth weight • Chorioamnionitis • Maternal fever

  10. NEONATAL SEPSIS Etiology • Gram (+) cocci – Group B beta hemolytic strep, S. aureus, S. epidemidis • Gram (-) cocci- E. coli, Klebsiellapneumoniae • Gram (+) rods – Listeriamonocytogenes

  11. NEONATAL SEPSIS Signs and Symptoms • Unexplained respiratory distress • Unexplained feeding intolerance • Temperature instability • Hypo/hyperglycemia • Apnea • Lethargy • Irritability

  12. NEONATAL SEPSIS Sepsis Work up • CBC • Blood culture • Lumbar puncture • Urinalysis • Chest xray

  13. NEONATAL SEPSIS Treatment • Empiric : penicillin + aminoglycoside, change antibiotic according to the result of culture • Nosocomial: antibiotics should depend on nursery exposure information • Duration: 7-10 days except for invasive infections i.e. osteomyelitis

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