How do sulfonamides cause kernicterus?

Sulfonamides may unbind bilirubin from albumin, which increases blood levels of bilirubin. The unbound bilirubin can cross into the brain and cause kernicterus.

Why kernicterus occurs in newborn?

Kernicterus starts with jaundice. Newborn jaundice occurs when there is an increase of a substance in the blood called bilirubin. Bilirubin is produced when red blood cells break down naturally. It is a toxic, yellowish substance that is removed from the blood by the liver and excreted from the body.

What are the 2 most common types of neonatal hyperbilirubinemia?

What are the different types of newborn jaundice?

• Physiological jaundice. The most common type of jaundice in newborns is physiological jaundice.
• Breastfeeding jaundice. Jaundice is more common in breastfed babies than formula-fed babies.
• Breast milk jaundice. Breast milk jaundice is different than breastfeeding jaundice.

When does kernicterus occur in neonates?

In some cases, symptoms and physical findings of kernicterus appear two to five days after birth. Within the first few days of life, affected infants develop abnormally high levels of bilirubin in the blood (hyperbilirubinemia) and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice).

Why sulfonamides are contraindicated in neonates?

Impaired conjugation of sulfonamides in the neonate can cause serious toxicity. Also, because of low renal plasma flow and glomerular filtration rate, the total body clearance rate of sulfonamides may be slow in the neonate. This may result in accumulation of unmetabolized drug in neonates, leading to toxicities.

Why is bactrim contraindicated in neonates?

BACTRIM contains benzyl alcohol as a preservative. Serious and fatal adverse reactions including “gasping syndrome” can occur in neonates and low birth weight infants treated with benzyl alcohol- preserved formulations in infusion solutions, including BACTRIM.

What level of bilirubin causes kernicterus?

Kernicterus, or bilirubin encephalopathy, is bilirubin-induced neurological damage, which is most commonly seen in infants. It occurs when the unconjugated bilirubin (indirect bilirubin) levels cross 25 mg/dL in the blood from any event leading to decreased elimination and increased production of bilirubin.

What are the four types of neonatal jaundice?

When babies breastfeed effectively, there is little chance of severe jaundice, but all parents need to be aware of the different types of jaundice.

• Pathologic jaundice. Pathologic jaundice is the most serious type of jaundice.
• Physiologic (neonatal) jaundice.
• Breast milk jaundice.
• Suboptimal intake jaundice.

How is kernicterus diagnosed?

Your doctor diagnoses kernicterus through a physical examination and knowledge of your child’s history of symptoms. Blood tests to measure your baby’s bilirubin levels are also done. Once a baby has kernicterus, brain damage has already occurred.

Why are sulfonamides avoided if possible for infants younger than 2 months of age?

Sulfamethoxazole; trimethoprim is contraindicated in neonates and infants younger than 2 months of age. Sulfonamides may cause bilirubin displacement and kernicterus in this age group.

Which is the major side effects of sulfonamide?

Rare

• Abdominal or stomach cramps and pain (severe)
• abdominal tenderness.
• blood in urine.
• diarrhea (watery and severe), which may also be bloody.
• greatly increased or decreased frequency of urination or amount of urine.
• increased thirst.
• lower back pain.
• pain or burning while urinating.

Can bactrim be used in neonates?

Pediatric Use BACTRIM is contraindicated for infants younger than 2 months of age (see INDICATIONS and CONTRAINDICATIONS sections).

Why is ceftriaxone not used in neonates?

ceftriaxone is not recommended for use in neonates with hyperbilirubinemia because ceftriaxone displaces bilirubin from albumin binding sites increasing unconjugated plasma concentration. Concurrent administration of ceftriaxone and calcium-containing solutions is contraindicated.

What is the difference between kernicterus and bilirubin encephalopathy?

Bilirubin encephalopathy is a rare neurological condition that occurs in some newborns with severe jaundice. Kernicterus is a condition where very high bilirubin levels in the blood are deposited in the brain tissue causing irreversible damage to the brain.

At what level of bilirubin does kernicterus occur?

When does kernicterus start?

What is hypoglycemia in neonatal intensive care?

Hypoglycemia is one of the most common pathologies encountered in the neonatal intensive care unit and affects a wide range of neonates. Preterm, small for gestational age (GA) and intra-uterine growth restricted neonates are especially vulnerable due to their lack of metabolic reserves and associated co-morbidities.

How does hypoglycemia affect infants’neurodevelopmental impairment?

Infants that experienced hypoglycemia (glucose <47 mg/dL) on 5 or greater days had 3 to 5 times increased risk of neurodevelopmental impairment. The authors concluded that “even moderate hypoglycemia is associated with a considerable increase in adverse neurodevelopmental sequelae” and called for a reevaluation of the then current practice trends.

Is dextrose gel effective in the treatment of neonatal hypoglycemia?

Oral dextrose gel is increasingly being recommended as a first-line treatment for neonatal hypoglycemia. There is some evidence that even transient and clinically undetected episodes of neonatal hypoglycemia are associated with adverse sequelae, suggesting that prophylaxis should also be considered.

How is Neonatal hypoglycemia diagnosed?

Diagnosis of neonatal hypoglycemia is done with a serum glucose test. It is a blood test that measures blood sugar in a newborn using a heel stick, an easy and minimally invasive way do blood work for newborns where blood is drawn from the heel of the foot.