What are the 2 main reasons that infants get jaundiced?
- Underdeveloped liver can’t conjugate the bilirubin
2. Lack of GI flora to metabolize bile, so the bilirubin is re-unconjugated and sent back into the bloodstream
What form of bilirubin can cross the BBB?
Unconjugated
What 2 parts of the brain are affected by Kernicterus?
- Basal ganglia
2. Cranial nerve nuclei
What are the effects of kernicterus in the brain?
Tone/reflex abnormalities, choreoathetosis, tremor, oculomotor paralysis, sensorineural hearing loss, cognitive impairment
Aside from opioid withdrawal, what can cause a high-pitched cry in a newborn?
Acute bilirubin encephalopathy
When does acute bilirubin encephalopathy occur?
Within the first few weeks of life
What type of bilirubinemia does phototherapy cure?
Unconjugated
What type of jaundice is
Physiologic jaundice
Which type of jaundice happens the first week in life and is caused by a relatively low milk supply, leading to low enteric intake, decreased GI motility, and increased B-glucoronidase activity?
Breastfeeding (or lack of breast-mik) jaundice
Which type of jaundice happens within the first 4-7 days of life but peaks around days 10-14, and has an unclear etiology?
Breast milk jaundice
What test is positive in antibody-positive hemolysis, such as Rh, ABO, minor antigen incompatibility?
Direct COOMBS (DAT)
What can bruising from birth trauma, large cephalohematoma, polycythemia, or swallowed blood during delivery all cause?
Jaundice due to non-hemolytic RBC breakdown
What are 2 rarer causes of jaundice?
Crigler-Najjar and Gilbert Syndrome
Can galactosemia and hypothyroidism cause jaundice?
Yes
What might be the cause of jaundice in the newborn with hepatosplenomegaly, microcephaly and/or rash?
TORCH infection
Which 3 infections does breastfeeding protect against?
- Otitis media
- Respiratory infections
- Diarrhea
Does breast milk contain growth factors?
Yes
Is colostrum higher or lower in non-nutritive but beneficial substances?
Higher
When can a child first drink unmodified cow milk?
Age 1
Approximately 50% of calories in human milk come from ______?
Lipids
Why is it important that an infant empty the breast before going to the next breast?
Because the highest lipid concentration is at the end of the session
What’s the whey:casein ratio in breast milk?
70:30
A healthy-appearing infant who develops jaundice, dark urine, and pale stools between 3-6 weeks may have ______ ______?
Biliary atresia
Any infant who develops jaundice after 2 weeks of age must be evaluated with __________ bilirubin?
Fractionated (i.e., total and direct bilirubin levels)
What surgical procedure can fix biliary atresia by anastomosing the intrahepatic bile ducts to a loop of intestine?
Kasai procedure
How often should the infant urinate by day 3?
3 times
How often should the infant urinate by day 6?
6 times
What color should infant urine be?
Pale yellow
What should the infant stool be like at day 3?
Meconium should be gone and stool appears yellow
How many times should infants poop by day 6?
3-4, or after every feed
Should infant stool smell bad?
No, it should have very little odor
What’s a subperiosteal hemorrhage that is localized to the cranial bone that was traumatized during delivery, and does NOT extend across suture lines?
Cephalohematoma
What’s an edematous swelling over the presenting portion of the scalp of an infant that has boggy swelling that DOES cross suture lines?
Caput succadaneum
What’s the average diameter of the anterior fontanelle?
2.5-5cm
Is the posterior fontanelle palpable at birth or later in most full term newborns?
No
Is a liver edge palpable 1cm below the inferior costal margin a normal finding in a newborn?
Yes
What do infants with galactosemia present with (3)?
- Hepatomegaly
- Ascites
- Edema
Breastfed infants may lose up to ___% of their birthweight in the first 5 days?
10%
What does Vitamin D rickets usually respond to?
Vitamin D
At what age should babies receive fluoride supplements if their water lacks it?
6 months