Neonatal hyperbilirubinemia Unconjugated

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Neonatal hyperbilirubinemia Unconjugated by Mind Map: Neonatal hyperbilirubinemia Unconjugated

1. bilirubin catabolism

1.1. RBC lysis-waste products-->unconjugated bilirubin

1.1.1. bilirubin binds to albumin-->liver--> conjugated from lipid-soluble to water-soluble from UGT1A1 enzyme

1.1.1.1. conjugated bilirubin--> bile ducts--> intestines--> excreted in stool

1.1.1.1.1. some conjugated bilirubin can become unconjugated thru Beta-glucuronidase(enterohepatic recirculation)

2. Benign Neonatal Hyperbilirubinemia/physiologic jaundice

2.1. peaks @ 48-96hrs of life (7-9mg/dl)

2.1.1. resolves by 2 weeks; increased breakdown of fetal RBCs; immature/inefficient liver; increased enterohepatic circulation

2.2. Increased production due to hemolysis of RBCs

2.2.1. ABO or Rh incompatibility

2.2.1.1. RBC membrane defects

2.2.1.1.1. erythrocyte enzyme defects; birth trauma; sepsis

3. etiologies of unconjugated hyperbilirubinemia

3.1. decreased hepatic clearance

3.1.1. Crigler-Najar 1 and 2

3.1.1.1. really broken UGT1A1

3.1.2. Gilbert syndrome

3.1.2.1. Kind of broken UGT1A1

4. screening for hyperbilirubinemia

4.1. clinical assessment

4.2. Risk Factors

4.2.1. ABO/Rh incompatibility

4.2.2. prematurity

4.2.3. bruising/trauma, cephalohematoma

4.2.4. East Asian race

4.2.5. exclusive breastfeeding

4.2.6. siblings w/ jaundice

4.3. serum total & direct bili levels

4.4. may use Bhutani nomogram or Bili calculator to treat

4.5. careful discharge planning/f/u

5. Management of unconjugated bilirubin

5.1. Hydration/Feeding

5.2. Phototherapy

5.3. Exchange transfusion

5.4. sunny window is not evidence-based!

6. Treatment/Outcomes

6.1. Bilirubin-induced neurologic dysfunction (BIND)

6.1.1. Cytologic & molecular damage to basal ganglia from unconjugated bilirubin

6.2. Acute bilirubin encephalopathy(ABE)

6.2.1. seizures

6.2.2. encephalopathy

6.2.3. lethargy

6.3. Chronic bilirubin encephalopathy(CBE)

6.3.1. AKA Kernicterus

6.3.2. Chronic & permanent sequelae

6.3.3. sensorineural hearing loss

6.3.4. Cerebral palsy