Neonatal Jaundice
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 25 March 2018
⏱️ 9 minutes
🧾️ Download transcript
Summary
Physiology
* RBC hemoglobin breakdown -> unconjugated (indirect) bilirubin* Unconjugated (indirect) bilirubin -> liver -> conjugated (direct) bilirubin* Conjugated (direct) bilirubin -> Eliminated in stool
Causes of Hyperbilirubinemia
* Increased RBC turnover* Sepsis* Rh incompatibility* RBC disorders* Maternal diabetes* Scalp hematoma* Decreased/slow conjugation by the liver* Peaks around day 5 of life* Congenital liver disorders* Gilbert/Crigler Najjar Syndromes* Breast milk jaundice* Breast milk inhibits conjugation of bilirubin* Decreased excretion* Bowel obstruction* Breast feeding failure (dehydration)* Decreased stool output results in reabsorbed bilirubin
Kernicterus
* Brain damage from severe hyperbilirubinemia (>25 mg/dL)* Compare measured bilirubin to established nomogram* Treatment is phototherapy* (Worst case scenarios require exchange transfusion)
Additional Reading
* Approach to Neonatal Jaundice (emDOCs)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast. |
| 0:10.7 | We're doing some more Peds this week. Today, we're talking about neonatal jaundice. And I like this topic, because not only is it important in the department, you do see this, |
| 0:21.6 | but it's also going to be on step two. |
| 0:23.8 | So it's really high yield. |
| 0:25.8 | What you really need to remember about neonatal jaundice is the physiology. |
| 0:32.7 | Blood cells break down at either a normal or accelerated pace in some cases, and it releases unconjugated, |
| 0:41.8 | undirected, undirected, Billy Rubin into the blood. And this unconjugated Billy Rubin that has |
| 0:48.1 | no purpose or direction in its life eventually floats on over to the liver. In the liver, this unconjugated, undirected, |
| 0:57.3 | biliruturban finds its purpose. |
| 1:00.2 | Its purpose is to leave the body, |
| 1:03.1 | and the liver conjugates it. |
| 1:04.7 | It gives it directions, and it directs it out. |
| 1:07.9 | Head on over to the GI tract, |
| 1:09.6 | follow your nose, and the stool will take you up from there. |
| 1:12.5 | That's how it works. And in adults, our Billy Rubin is really low because this process is |
| 1:19.5 | completely streamlined. But sometimes things don't flow efficiently. And this is especially true in kids. |
| 1:28.5 | And that's why babies especially can get jaundice. |
| 1:32.1 | It's that Billy Rubin building up. |
| 1:34.7 | And if that Billy Rubin hits 25, even less in some of the higher risk kids, they get brain |
| 1:42.3 | damage. |
| 1:42.8 | They get carnictorous. |
| 1:45.4 | And so we have two jobs in an apartment when we have a patient with neonatal jaundice. |
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