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Neonatal Jaundice (Recap of the biliary system…again (intrahepatic 2,3…

- - - - Tx: Phototherapy
        
        UB →(light)→ CB (or ionized bili)
        
        blue light
        
        prevents Kernicterus
        
        if really high UB
        
        Exchange Transfusion
- - - - Coombs Test
        Mom's Ab attacking baby blood?
        
        (+) Isoimmunization
        
        (-) Shit, not that
        Look at the Hb
        
        most UB'emia from hemolysis from hematomas
        
        ↓Hb
        
        Hemorrhage
        
        cephalohematoma
        
        ↑Hb
        Transfusion
        
        Twin-Twin
        
        2 fetus, 1 placenta (∆ blood amount)
        
        scrawny one does better
        
        bigger one does worse 2/2 bili
        
        delayed clamping
        
        Maternal transfusion
        
        Hb
        
        check reticulocyte count
        
        ↑reticulocytes
        
        hemolysis
        
        this early = G6PD deficiency
        
        or Pyruvate Kinase deficiency
        
        or Hb-SS disease
        
        reticulocytes
        
        Reabsorption problem
        
        exaggerated examples of physiologic jaundice; baby is tech fine
        
        Breast Feeding Jaundice
        Path: Quantity, not enough feeds
        
        decr bowel function, bili stasis → reabsorption
        
        Day 1-7
        
        UB
        
        Tx: Feed baby more
        
        Breast Milk Jaundice
        Path: Quality, mom's milk inhibits conjugation
        
        UB
        
        ≥ day 7
        
        keep up the feeds, remove inhibitory enzyme
        
        use hydrolyzed formula
    - - U/S
        HIDA post phenobarbital
        Sepsis r/o
        Metabolic derangement/Genetic (dx of ex)