Evaluation and Treatment of Neonatal Hyperbilirubinemia KAREN E. MUCHOWSKI, MD, Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, California Am Fam Physician. 2014 Jun 1;89(11):873-878.
Severe neonatal hyperbilirubinemia can cause kernicterus in about 2% of infants, however it is usually benign. Symptoms include hypertonia, arching, retrocollis, opisthotonus, fever, and high pitched crying. Risk factors include cephalohematoma, bruising, exclusive breast feeding, and weight loss greater than 8%. Total serum bilirubin (TSB), transcutaneous bilirubin, or risk scores can be used to screen patients. Some institutions prefer to do universal screening. AAFP says that screening has no effect on clinical outcomes.
It is important for the old-timer docs to know that you can not visually predict bilirubin level though visual inspection. It is more accurate to plot the level on a nomogram HERE (BTW that was my first ever link on my blog- go me!" The treatment is typically phototherapy (at a frequency of 460-490 nm). There is no standard protocol for exact type or amount of light. Fiber optic lights are only about half as good as conventional. Adverse effects of phototherapy include separation from mom, increased blood draws, longer hospital stays, and more visits to health care professionals during infancy. Exchange transfusion is considered if the patient has a TSB above 25 ng/dL and signs of encephalopathy. Complications occur 5% of the time.
Hyperbilirubinemia is more a function of calorie deprivation rather than breastfeeding exclusivity. frequency needs to be increased in these children. Intake can be approximated by monitoring daily wet diapers (4-6 is adequate) and stools (3-4). Encouragement and continued maternal interaction by doctors and nurses is helpful in promoting breastfeeding throughout infancy.
Studies on long term effects have shown no difference in cognition or neurologic function between patients with RSB levels above or below 13. Those with a positive coombs test had lower cognitive scores. Infants with TSB above 19 have had an increased incidence of ADD.
Evaluation and Treatment of Neonatal Hyperbilirubinemia KAREN E. MUCHOWSKI, MD, Naval Hospital Camp Pendleton Family Medicine Residency Program, Camp Pendleton, California Am Fam Physician. 2014 Jun 1;89(11):873-878.
Severe neonatal hyperbilirubinemia can cause kernicterus in about 2% of infants, however it is usually benign. Symptoms include hypertonia, arching, retrocollis, opisthotonus, fever, and high pitched crying. Risk factors include cephalohematoma, bruising, exclusive breast feeding, and weight loss greater than 8%. Total serum bilirubin (TSB), transcutaneous bilirubin, or risk scores can be used to screen patients. Some institutions prefer to do universal screening. AAFP says that screening has no effect on clinical outcomes.
It is important for the old-timer docs to know that you can not visually predict bilirubin level though visual inspection. It is more accurate to plot the level on a nomogram HERE (BTW that was my first ever link on my blog- go me!" The treatment is typically phototherapy (at a frequency of 460-490 nm). There is no standard protocol for exact type or amount of light. Fiber optic lights are only about half as good as conventional. Adverse effects of phototherapy include separation from mom, increased blood draws, longer hospital stays, and more visits to health care professionals during infancy. Exchange transfusion is considered if the patient has a TSB above 25 ng/dL and signs of encephalopathy. Complications occur 5% of the time.
Hyperbilirubinemia is more a function of calorie deprivation rather than breastfeeding exclusivity. frequency needs to be increased in these children. Intake can be approximated by monitoring daily wet diapers (4-6 is adequate) and stools (3-4). Encouragement and continued maternal interaction by doctors and nurses is helpful in promoting breastfeeding throughout infancy.
Studies on long term effects have shown no difference in cognition or neurologic function between patients with RSB levels above or below 13. Those with a positive coombs test had lower cognitive scores. Infants with TSB above 19 have had an increased incidence of ADD.
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