Hyperbilirubinemia RECS Learning Module

Objectives

1. Differentiate between the different types of jaundice
2. Understand bilirubin synthesis, transport, and metabolism
3. Distinguish between physiologic jaundice in a full-term infant and physiologic jaundice in a preterm infant
4. Recognize that breast-feeding is the most frequent cause of exaggerated unconjugated hyperbilirubinemia in the neonatal period.
5. Know the management of breast milk jaundice
6. Describe the clinical manifestations of acute bilirubin encephalopathy
7. Recognize that diagnostic studies are needed to detect hemolytic diseases in a full-term infant who becomes clinically icteric during the first day after birth
8. Understand that sepsis, galactosemia, and endocrine disorders can be readily diagnosed in the neonate with conjugated hyperbilirubinemia
9. Know the appropriate diagnostic tests to establish the cause of unconjugated hyperbilirubinemia
10. Plan when an infant should be seen for follow-up in the outpatient setting based on gestational age at discharge
11. Understand the strategies for prevention of severe hyperbilirubinemia in newborn infants such as increasing frequency of breastfeeding
12. Formulate a differential diagnosis of infectious causes of jaundice in an infant

Articles/Resources

Pediatrics (2004) 

Peds in Review (2011)

Self-quiz:

1. Define the two different types of jaundice.  Name several different etiologies for each.
2. List at least 6 risk factors for the development of severe hyperbilirubinemia in infants of 35 weeks gestation or more.
3. What labs does the AAP recommend for an infant who is jaundice beyond 3 weeks of age?
4. What total serum bilirubin level requires admission into the hospital for exchange transfusion?
5. Describe the management of the infant with breast-milk jaundice. How can you tell the difference between physiologic and breast-milk jaundice?
6. What labs should be obtained in an infant with a rising bilirubin despite phototherapy?
7. What are the clinical manifestations of acute bilirubin encephalopathy?
8. What diagnostic studies should be obtained in a full term infant who becomes icteric in the first 24 hours after birth?
9. Understand when an infant should be seen for follow-up in the outpatient setting based on gestational age at discharge.
10. Understand the strategies for prevention of severe hyperbilirubinemia in newborn infants such as increasing frequency of breastfeeding.
11. Formulate a differential diagnosis of infectious causes of jaundice in an infant.

Helpful links:

BiliToolTM

Reviewed 11/ 2017