hyperbilirubinemia

• Pathological: first 24 hours, ABO incompatiability
• Physiological: occurs after 24 hours, expected in the newborn period
• total serum bilirubin level above 5mg/dl, results when unconjugated bilirubin is deposited in the skin and mucous membranes
• Jaundice- occurs in 60%-80% of term newborns 100% preterm newborns
• 3 main mechanisms causing increased bilirubin:

  1. increased production(accelerated RBC breakdown)
  2. decreased removal(transient liver enzyme insufficiency)
  3. increased reabsorption(delay in bowel excretion)
• complication: potenial for brain injury; ranges from acute bilirubin encephalopathy to irreversible chronic bilirubin encephalopathy or kernictecus
• kernicterus: bilirubin moves from bloodstream into brain tissue
• signs and symptoms: jaundice, tea coloured urine, lethargy, poor feeding
• nursing management: early initiation of feeding, phototherapy, hydration, exchange infusion, patient teaching and support
• serum bilirubin: detercts hyperbilirubinemia and results plotted to a graph, considers age of baby and weeks of gestation
• DAT: detects antibodies attached to red blood cells, also known and Coombs test: can help to identify pathological jaundice in neonates
• Phototherapy: process of using light to eliminate bilirubin in the blood, baby skin and blood absorb light waves and change bilirubin into products which can pass through their system
• Phototherapy: used to convert unconjugated bili to conjugated bili- less toxic water-soluble form that can be excreted
• Phototherapy: can impact bonding, use biliblanket when feeding
• nursing interventions:

  • expose as much skin as possible
  • cover newborn genitals and shield eyes
  • assess intensity of light source to prevent burns
  • maintain neutral thermal environment to decrease energy expenditure
  • monitor fluid intake and output