0071643192.pdf

PEDIATRICS

TREATMENT

Once the diagnosis is made, treatment involves reassuring the parents that

colic is normal and will resolve spontaneously without intervention. Pharma-

cologic therapies are not generally effective. Simethicone, while generally

safe, is no more effective than placebo. Dicyclomine (an anticholinergic) may

improve symptoms of colic, but is contraindicated in infants under the age of

6 months due to possible side effects of sedation, apnea, coma, and seizures.

Other interventions that may provide some benefit in symptoms include

changes in feeding technique, gentle motion (such as driving a car), and tight

swaddling.

COMPLICATIONS

■ Child abuse

■ Disruption in breastfeeding

■ Increased risk of maternal depression

Neonatal Jaundice

Healthy, full-term infants normally develop some degree of physiologic jaun-

dice in the first 4 days of life due to the metabolism of red blood cells (see

Figure 5.1). Elevated serum bilirubin can damage the infant’s brain, causing

irreversiblekernicterus. Kernicterus is rare, but is a known and preventable

cause of cerebral palsy.

Newborns are at high risk for developing jaundice for multiple reasons.

■ Prematurity (immature hepatic conjugation system)

■ Breastfeeding (mild dehydration in interval before mother starts to produce

milk)

■ Increased bilirubin load delivered to liver

■ High fetal RBC volume (polycythemia)

■ Decreased fetal RBC survival (cephalohematoma provides an addi-

tional source of RBC breakdown usually from forceps or vacuum-

assisted delivery)

Albumin

Biliverdin Bilirubin

Enterohepatic

circulation

Fecal bilirubin

Conjugated bilirubin

excreted into bowel

Conjugated to form

bilirubin glucuronide

Liver

Heme oxygenase

RBC

FIGURE 5.1. Summary of red blood cell (RBC) metabolism.