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Date: | Thu, 29 Apr 1999 23:52:21 -0400 |
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It is my understanding that bilirubin is excreted via the bowel. You also
need to know if baby had a positive or negative Coomb's test, and what were
the values for direct bilirubin. If the value for direct bili was >1.5
mg/dl different problems need to be checked out. But assuming that was all
done, I nurse and not dress baby in yellow :-)
Don't forget the article
on Jaundice in the current issue of Contemporary Pediatrics, 16(4), p.
166-183. I'll try to do a flow chart, but I'm not sure if it will work on
e-mail. And no I don't remember where I got this :-( It says 236 Ch. 16
Neonatal Hyperbilirubinemia at the top of the spiral bound page. It is
fig. 16-1.
Sincerely, Pat in SNJ
Clinical jaundice ----------------------------------------
I I
V V
Bili> 12 mg/ml Bili < 12 mg/dl
and infant <24 hours old and infant > 24 hours old
I
V
Coombs' Test-------------------------------------------------------
I I
V V
Positive Coombs' -------------------Negative
Coombs'-----------------
I I
I
V V
V
Identify antibody Direct bili >1.5
Direct bili <1.5
* Rh Consider:
I
* ABO *Hepatitis
V
* Kell, etc. * Intrauterine, viral or
---------- Hematocrit----
toxoplasmatic inf.
I I
* Biliary Obstruction
V V
* Sepsis
Normal or low High
* Galactosemia I
(polycythemia)
* Alpha-1-antitrypsin def. I
* Cystic fibrosis I
* Tyrosinosis I
* Cholestosis I
* Recd. Hyperal? I
V
RBC morphology
------------------------------------Reticulocyte count----------
I I
V V
Abnormal:
Normal:
*Sphereocytosis * enclosed
hemorrhage
*Elliptocytosis * increased enterohepatic
*Stomatocytosis
circulation
*ABO incompatibility * breast milk :-(
*Red cell enzyme deficiency * Lucey-Driscoll syndrome
*Alpha Thalassemia * hypothyroidism
*Drugs (eg. PCN) * Crigler-Najjar syndrome
*DIC * Infant of diabetic mother
* RDS
* Asphyxia
* Infection
* Gilbert's syndrome
* Drugs (eg. Novabiocin)
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