- Extreme jaundice
- Poor feeding and sucking
- Extreme lethargy and sleepiness
- Low muscle tone (hypotonia)
- High pitched cry
- Bulging on "soft spot" fontanel
- Arched back and hyperextended neck (hypertonia)
- Extreme muscle rigidity
- Hearing loss
- Stupor, coma, death
Long Term Impact
- Hearing loss
- Cerebral Palsy
- Impaired mental development
- Kernicterus (irreversible brain damage)
1. Physiologic: "normal" response to life
In utero, fetus relies on the mother's placenta to safely remove bilirubin from the circulatory system. At birth, the babies' immature liver cannot process the BR.
2. Breast Feeding Failure Jaundice
If a breastfed baby becomes dehydrated waiting for their mother's breast milk to come in, they will produce less urine and BR will accumulate. This occurs in healthy, full term babies, and once feedings increase, the jaundice should fade.
3. Hemolysis: Mom/Baby Blood Incompatibility
Hemolysis is simply the breakdown of red blood cells. This commonly occurs when the mom and the baby have different blood types.
Hemolysis (RBC breakdown) > Clearance = JAUNDICE
TWO TYPES OF INCOMPATIBILITY
1. ABO Incompatibility: Even in healthy pregnancies it is common for the mother to have a different blood group than the baby. This will occur if the mother is type O and the baby is either A, B or AB.
2. Rhesus (Rh) Incompatibility: A more specific indicator that notes the "minor" blood type as either Rh (+) or Rh (-). Pregnancies are at risk when the mother is Rh(+) and the baby is Rh(-).
In both cases of incompatibility, when the mother's and babies' blood mixes in utero, the mother's immune defense system will identify the babies' red blood cells as foreign and develop antibodies against them. Once the baby is born, these antibodies will attack the babies' blood cells. This hemolysis of red blood cells causes hyperbilirubinemia.
Question #2: Which type of incompatibility is more severe?
Rh incompatibility is more severe then ABO, and more likely to place a newborn at risk for HDN (hemolytic disease of a newborn) associated complications.
- ABO is limited only to cases in which the mother is type O and baby is type A, B or AB
- A limited amount of ABO antibodies will cross into the placenta
- Newborn RBCs have less surface expression of the anti-A and Anti-B antigens
- However, the Anti-IgG antibodies (Rh type) can readily cross the placenta and yield a more severe immune response.
Question #3: Which lab test is used to detect the presence of maternal antibodies against the babies' blood??
A. Rh screening test
B. Direct Antibody Test
C. Coomb's test
D. PKU test
The "Coombs Test" = Direct Antibody Test
Rh is one of the tested antibodies.
1: LOOK for Jaundice!
2. Monitor serum levels. Continue to monitor and plot babies' bilirubin if they are at a moderate to high risk.
Transcutaneous Test (TcB): Nurse swipes a handheld device across the babies' forehead.
Serum Test (SBR): Laboratory test from the umbilical cord or a heel stick blood sample.
3. Encourage breastfeeding or Formula boosts: If an exclusively breastfed baby is not feeding well for during days 1-3 you could try to increase hydration with a formula feeding before the mother can effectively breastfeed.
4. Phototherapy Lights: Blue wavelength light is absorbed into the babies' skin and aids in the breakdown of unconjugated bilirubin into a less toxic, water-soluble compound. The newborn must be naked except for an eye-shield and a diaper. For extra strength light therapy, the newborn can lay on top of a fiberoptic pad.
5. Exchange transfusion: Although these are rarely indicated, if phototherapy is not effective, this procedure will rapidly decrease the serum bilirubin levels. Th exchange transfusion will remove any red blood cells that have been hemolyzed and replace them with donor red blood cells without the antibody against their blood type.
This procedure poses risks for air embolism, infection, vasospasm, and even death. It will only be performed if other options have been exhausted and are unsuccessful at lowering the SBR.
6. RhoGam immunoglobin
Question #4: In which scenario will a mother receive the RhoGam immunoglobin?
A. Mother is A+ and the baby is B+
B. Both the mother and baby are A+
B. Mother is A- and the baby is B-
D. Mother is A- and the baby is A+
When a mother is Rh- and the baby is Rh+ the mother will receive the RhoGam shot to protect the current fetus and any future embryos from the risk of hemolysis related conditions. She will receive a shot around week 28, week 34 and post delivery.
7. Education!!!! Sometimes jaundice appears several days after birth, after parents have already taken their baby home. Although this is uncommon with vigorous screening for bilirubin levels in the hospital, babies with poor feeding can develop jaundice. Parents need to know when it is necessary to call their provider.
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