Common issues with feeding
Feeding
Hyperbilirubenemia
Seeing yellow
Pathophysiology
100

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

100

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.

100

which type of bilirubin gets excreted 

Conjugated

100

Usually present after day 3-4 and resolves within 2 weeks

Physiologic jaundice

100

Water soluble enzyme in the liver that binds to bilirubin to make it conjugated

Glycoronic acid

200

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

200

What percentage of maternal dose of a drug do breastfeeding infants take in

1%-2%

200

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

200

lethargy, hyper- or hypotonia, poor suck, high-pitched cry

Acute bilirubin encephalopathy

200

secreted into the bile, and then excreted into the digestive tract

Conjugated bilirubin

300
Mom brings her 7 day old formula fed infant because he keeps spitting up after feeding. She reports he usually is not bothered by it. He is eating 8x a day about 2-3 ounces at a feeding and his weight gain is normal. Your next action is 

to tell mom this is normal and reassure. He is a 'happy spitter'

300

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

300

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. 

300

Appears after 7 days of life and may last  for one month or more

Breast milk jaundice

300

breakdown of hemoglobin from red blood cells or from ineffective erythropoiesis

Bilirubin

400

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

400

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

400

Main goal of Prompt treatment of hyperbilirubinemia is 

Prevention of Kernicterus (Irreversible brain damage)

400

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

400

The initial circulating bilirubin bound to albumin is transported to the liver is

unconjugated

500

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

500

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. 

500

The most COMMON cause for elevated bilirubin levels in the first 24 hours is

Hemolysis

500

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

500

which type of bilirubin cannot be reabsorbed so it is excreted

Conjugated bilirubin