Common issues with feeding
Infant born to GBS positive mom has a red rash that is well delineated in diaper area. Stools are loose, seedy and yellow. Most likely cause for the rash is
Thrush/Candida
Newborn born at 8lb 3oz. At discharge 3 days after birth he was 7lb 8oz. At your office at 1 week of age he is 7lb 10 oz. What is your next course of action.
Keep reassuring mom. Infants gain 0.5-1 ounce a day.
which type of bilirubin gets excreted
Conjugated
Usually present after day 3-4 and resolves within 2 weeks
Physiologic jaundice
Water soluble enzyme in the liver that binds to bilirubin to make it conjugated
Glycoronic acid
33 yo mom with a 4 week old infant has been diagnosed with Mastitis. You have started her on Dicloxicyllin for 10 days. You also instruct her to..
Continue to breastfeed and pump often
What percentage of maternal dose of a drug do breastfeeding infants take in
1%-2%
If you press over the bony prominence on an infant and the skin has a yellow hue you know the bilirubin level is equal or greater than
5 ml/dl
lethargy, hyper- or hypotonia, poor suck, high-pitched cry
Acute bilirubin encephalopathy
secreted into the bile, and then excreted into the digestive tract
Conjugated bilirubin
to tell mom this is normal and reassure. He is a 'happy spitter'
How much is an average weight formula fed infant should be expected to take in 24 hour period
2-3 oz/60-90 ml every 2-3 hours
Which infant is at risk for hyperbilirubinemia
1. An infant born at 37 weeks
2. An infant with ABO incompatibility
3. An 2 day old infant that has had 1 bowel movement
4. A bottlefed infant that is having 1/2 ounce every 3 hours.
An infant with ABO incompatibility. Causes hemolysis breakdown of RBC's.
Appears after 7 days of life and may last for one month or more
Breast milk jaundice
breakdown of hemoglobin from red blood cells or from ineffective erythropoiesis
Bilirubin
Mom brings her 1 month old to your office because baby has been crying a lot. She is concerned about colic. In order to evaluate colic you know that the baby must have
Rule of 3:
Crying more than 3 hours, 3 or more days a week for more than 3 weeks
24 yo woman is breastfeeding her 6 week old infant. She asks you for suggestions on what is the best method of BC if she wants to continue to breastfeed. You respond.
Progesterone only formulations, IUD, barriers
Main goal of Prompt treatment of hyperbilirubinemia is
Prevention of Kernicterus (Irreversible brain damage)
You are called by the nurse who thinks that your patient in the nursery is a little jaundiced. His Bilirubin level is 5 ml/dl at 24 hours. At 48 hours level is 8 ml/dl. What is your next course of action.
Reassure the nurse as these levels are low risk
The initial circulating bilirubin bound to albumin is transported to the liver is
unconjugated
If a baby with colic has no red flags and you suspect CMPA (Cow's milk allergy) you encourage mom to...
Answer both for breast and formula fed
Breast: Eliminate cow's milk from diet
Formula: Change to soy milk formula
What is the correct way to teach a new mom how to get baby off the breast.
'Break the seal'. Insert pinky between mouth and breast.
The most COMMON cause for elevated bilirubin levels in the first 24 hours is
Hemolysis
You have done a bilirubin level on your newborn patient at discharge. You instruct mom to make an appointment to come to see you for the next level in
3-5 days
which type of bilirubin cannot be reabsorbed so it is excreted
Conjugated bilirubin