RESidENcy PROGRAM Scholarly and Community Medicine Projects
RESidENcy PROGRAM Scholarly and Community Medicine Projects
RESidENcy PROGRAM Scholarly and Community Medicine Projects
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ABE<br />
Maximum possible score is 9. Scores of 4-6 usually indicate<br />
reversible ABE. Progression to higher scores indicates<br />
worsening BIND. 4<br />
Screening<br />
● USPTF – insufficient evidence to recommend for or against<br />
universal bilirubin screening (І rating) 5<br />
● lack of evidence that universal bilirubin screening prevents<br />
bilirubin encephalopathy, insufficient evidence regarding risks <strong>and</strong><br />
efficacy of phototherapy<br />
● AAP Practice Guideline (updated 10/2009) 6<br />
● universal predischarge bilirubin screening using total serum<br />
bilirubin (TSB) or transcutaneous bilirubin (TcB)<br />
● structured approach to management <strong>and</strong> follow-up according to<br />
predischarge TSB/TcB, GA, <strong>and</strong> other risk factors for<br />
hyperbilirubinemia<br />
Nomogram of hour-specific total serum<br />
bilirubin (TSB) concentration in healthy term<br />
<strong>and</strong> near-term newborns<br />
BIND (cont'd)<br />
● Kernicterus - chronic <strong>and</strong> permanent sequelae of BIND 4<br />
● Develops during first year after birth<br />
● Cognitive function usually relatively spared<br />
● Major features:<br />
– Choreoathetoid cerebral palsy (chorea, ballismus, tremor <strong>and</strong><br />
dystonia)<br />
– Sensorineural hearing loss<br />
– Gaze abnormalities, especially limited upward gaze<br />
– Dental enamel dysplasia<br />
AAP Predischarge Risk Assessment<br />
● TSB – can be measured from blood draw for newborn<br />
screen<br />
● For nomogram, use total bilirubin (do not subtract direct<br />
bilirubin)<br />
● Assess GA <strong>and</strong> other risk factors:<br />
● Exclusive breastfeeding, esp if nursing not going well <strong>and</strong>/or<br />
weight loss is excessive (>8 –10%)<br />
● Isoimmune or other hemolytic disease (eg, G6PD deficiency,<br />
hereditary spherocytosis)<br />
● Previous sibling with jaundice<br />
● Cephalohematoma or significant bruising<br />
● East Asian race<br />
Management <strong>and</strong> follow-up based on predischarge<br />
TSB/TcB, GA, <strong>and</strong> other risk factors<br />
3
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