Monday, October 24, 2005

neonatal jaundice management - Google Search Kernicterus

neonatal jaundice management - Google Search

P.I.C.K. - Parents of Infants and Children with Kernicterus: "Kernicterus is a preventable neurologic disorder caused by newborn jaundice that can result in cerebral palsy, auditory processing problems (AN), gaze and vision abnormalities, and dental enamel hypoplasia. Newborn jaundice affects 60% of newborns in the United States each year and is the number one reason for hospital readmission during the first week of life. In the last ten to fifteen years, changes such as relaxed jaundice management guidelines, shortened hospital stays and reduced concern about jaundice in general have led to an increase in cases of excessive jaundice and acute and chronic kernicterus.

The long-term effects of excessive jaundice on the newborn brain can range from subtle (clumsiness, minor fine-motor deficits and sometimes slight AN) to severe (quadriplegia, total hearing loss, non-verbal). A few weeks after the severe jaundice incident, parents are typically able to identify abnormal newborn behaviors including poor feeding, irritability, sleep difficulty and muscle tone fluctuations. In addition, several secondary medical conditions are associated with kernicterus: severe reflux, sleep disturbances, respiratory infections and chronic constipation"

Management Neonatal Hyperbilirubinemia - Google Search

Chapter 1. Introduction: "However, there is continued concern that the rise in early hospital discharges, coupled with a rise in breastfeeding rates, has led to a rise in the rate of preventable kernicterus resulting from 'unattended to' hyperbilirubinemia (Sentinel Event Alert, 2001). A report published in 2002 (Johnson, Bhutani, and Brown, 2002), based on a national registry established since 1992, reported only 90 cases, although the efficiency of case ascertainment is not clear. Thus, there are no data to reliably establish incidence trends for either hyperbilirubinemia or kernicterus.
Despite these constraints, there has been substantial research on the neurodevelopmental outcomes of hyperbilirubinemia and its prediction and treatment. Subsequent sections of this review describe in more detail the precise study questions and the existing published work in this area."

Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 µmol per L) in infants 25 to 48 hours old, 18 mg per dL (308 µmol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 µmol per L) in infants older than 72 hours. Few term newborns with hyperbilirubinemia have serious underlying pathology. Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 µmol per L) per day or is higher than 17 mg per dL (290 µmol per L), or an infant has signs and symptoms suggestive of serious illness. The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity. (Am Fam Physician 2002;65:599-606,613-4. Copyright© 2002 American Academy of Family Physicians.)


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