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 Breastfeeding  30% 1960s  70% today  Strong association b/w breastfeeding and hyperbilirubinemia  “breastfeeding” vs “breast milk”

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Presentation on theme: " Breastfeeding  30% 1960s  70% today  Strong association b/w breastfeeding and hyperbilirubinemia  “breastfeeding” vs “breast milk”"— Presentation transcript:

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6  Breastfeeding  30% 1960s  70% today  Strong association b/w breastfeeding and hyperbilirubinemia  “breastfeeding” vs “breast milk”

7  AAP Recommendations  Any infant discharged <72hrs  Followup within 2 days  Infant with risk factors  Followup within 24hrs  Delay discharge if necessary  Weekends/holidays, etc.

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24  Mother Rh negative/ infant Rh positive  Decreased incidence with use of Rhogam  <1%

25  Most common immune mediated cause  Mother type O, infant A or B  15% of pregnancies  30% of these positive Direct Antibody Test  Anti-A or anti-B antibodies attached to red cells  Jaundice within 24hrs  Signs of hemolysis on smear  Severe jaundice uncommon

26  Most common red cell enzyme defect  4.5 million newborns each year  11-13% of African-American newborns  30% of infants with kernicterus in US  X-linked  Increased heme turnover  Overt evidence of hemolysis absent

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28  Visual inspection  Limited value  Dark skinned individuals  Post-phototherapy  Difference between 5 and 8 (50 and 95%ile at 24hrs) not perceived by eye  Some experts recommend TSB or TcB in all

29  Transcutaneous Bili  Screening tool  “should I worry about this infant?”  “should I obtain a TSB?”  Obtain TSB when:  TcB >75%ile  Post-phototherapy

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32  Exchange transfusion  Removes bili mechanically  Phototherapy  Converts bilirubin to soluble products  Bypass the liver

33  Expect 30-40% decrease in 24hrs  Insure that patient maintains hydration

34  430-490nm band of at least 30mcW/cm2 per nanometer  Special blue fluorescent tubes  Within 10-15cm to patient  ! DO NOT place halogen bulbs this close  Delivered to as much surface area as possible  Infant in diaper and eye shield only  Fiberoptic mattress beneath infant  Bililights above infant  Line sides of incubator with aluminum foil

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