Hyperbilirubinemia

REPORTED BY: LBSN4B

GROUP 2:NICU 7-3 SHIFT

DEFIINITION:

Hyperbilirubinemia is a condition in which the blirubin level in the blood is increased. It is characterized by a yellow discoloration of the skin, mucous membrane, sclera, and various organs.

The yellow discoloration is caused primarily by accumulation in the skin of unconjugated blirubin, a breakdown product of hemoglobin forming after its release from hemolysed RBCs.

Causes of hyperbilirubinemia in a newborn Prematurity Breast milk Excess production of bilirubin(hemolytic disease, bruises) Enzyme deficiency, bile duct obstruction Sepsis Diseases like hypothyroidism, IDM Genetic predisposition

Types of hyperbilirubinemia: 1. Physiological jaundice 2. Pathological jaundice

Physiological jaundice Pathological jaundice

Not appear before the 2nd or 3rd day in term baby. In premature baby, it appears after 3rd or 4th day.

Appears within the 1st day (24 hours after birth).

Physiological jaundice Pathological jaundice

I term newborn, it Needs longer time. disappears by the end of 7th days while in premature lasts for 9 to 10 days.

Physiological jaundice Pathological jaundice

The level of total serum Serum bilirubin exceeds bilirubin never exceeds that level. 12 mg/dl in fullterm newborn and 15 mg/dl in preterm newborn and the direct bilirubin does not exceed 1 mg/dl of the total bilirubin.

Physiological jaundice Pathological jaundice Daily raise of s. Bilirubin Serum bilirubin exceeds never exceed 5 mg/dl. the daily raise of physiological jaundice.

No kernicterus.

Cause kernicterus in indirect Hyperbilruibinemia.

Physiological jaundice Pathological jaundice Requires no treatment Treatment is important as soon as possible The newborn looks sick, poor sucking, pale, abnormal stool and urine color.

The newborn is good sucker, no anemia, not sick, normal stool, and urine color.

Newborn Jaundice Symptom As a baby's bilirubin levels rise, jaundice moves from the head to involve the arms, trunk, and finally the legs. If the bilirubin levels are very high, a baby will appear jaundiced below the knees and over the palms of his or her hands. One easy way to check for jaundice is to press a finger against your baby's skin, temporarily pushing the blood out of it. Normal skin will turn white when you do this, but jaundiced skin will stay yellow.

 Older children and adults will appear jaundiced when the amount of bilirubin in their blood is above 2 milligrams per deciliter (mg/dL). Newborn babies will begin to appear jaundiced when they have more than 5 mg/dL of bilirubin in their blood. It is important to recognize and treat neonatal jaundice because high levels of bilirubin can cause permanent damage to a baby's brain. This brain damage is called kernicterus. Today, because of increased awareness and effective treatment of neonatal jaundice, kernicterus is extremely rare.

 Jaundice itself does not produce any clinical symptoms, but the underlying cause may produce the following symptoms:
Ill appearance Fever Poor feeding

Kernicterus: It is also called the bilirubin encephalopathy and is caused by the deposition of the unconjugated bilirubin in the brain. It results in the yellowish staining of the brain tissue and the necrosis of neurons and occurs if the concentration of the unconjugated bilirubin reaches toxic level.

Stages of kernicterus: Stage 1: poor Moro reflex, poor feeding, vomiting, high-pitched cry, decreased tone and lethargy. Stage 2: opisthotonus, seizures, fever, occulogyric crises, and paralysis of upward gaze. Many newborns die in this phase. Stage 3: spasticity is decreased at about one week of age. (a symptomatic). Stage 4: progressive spasticity, deafness, and mental retardation.

Management of hyperbilirubinaemia: Increase feeds in volume and calories. Early feeding lowers serum bilirubin lever by stimulating the peristalsis. Stop drugs interfering with bilirubin metabolism. Correct hypoxia, infection, and acidosis. Phototherapy.
Prophylactic: in LBW or bruised neonate. Therapeutic.

Exchange transfusion.

Phototherapy: It consists of the application of fluorescent light (blue or white) to the newborns naked skin. Light causes break down of bilirubin by the process of photo oxidation. It alters the structure of bilirubin to a soluble form for easier excretion.

Indications of phototherapy: It is used when bilirubin level is: 5-9 mg/dl at the 1st day of life. 9-15 mg/dl at the 2nd day of life. 15-20 mg/dl at the 3rd day of life.

Side effects of phototherapy: Dehydration due to increased insensible water loss. Watery diarrhea. Hypocalcemia. Retinal damage. Erythema and skin rashs. Bronze baby syndrome. maternal newborn interaction is affected. Dark yellow urine.

Nurses responsibility in phototherapy: 1. The lamp should be 5-8 cm over the incubator. 2. Continue the feeding. 3. Shield the newborns eyes. 4. Keep newborn naked except for the diaper area and change position frequently. 5. Cleanse skin frequently to prevent irritation.

6. Maintain adequate fluid intake to prevent dehydration and calculate intake and output. 7. Check newborns body temperature every four hours. 8. Weight newborn daily. 9. Observe skin, mucous membranes, and stool. 10. Bilirubin levels should be followed for at least 24 hours after discontinuing phototherapy.

Exchange transfusion: It is an ideal dilution of s. Bilirubin and antibodies. A catheter is introduced into the umbilical vein after cutting the cord. Through a special valve, the umbilical catheter is connected with the donor blood. Exchange is carried out over 45-60 min period by alternating aspiration of 20 ml of newborns blood and infusions of 20 ml of the donor blood. .

Complications: Embolism, thrombosis, infarction. Arrhythmias, heart failure, arrest. Electrolyte disturbances. Thromobocytopenia. Infections Hypo and hyperthermia.

Nursing responsibilities: 1. Keep the newborn npo for 2-4 hours before exchange to prevent aspiration. 2. Check donor blood carts compatibility. 3. Keep resuscitation equipment at bedside: oxygen, ambo bag, endotracheal tubes, and laryngoscope. 4. Assist physician with exchange transfusion procedure.

5. Track amount of blood withdrawn and transfused to maintain balanced blood volume. 6. Maintain body temperature to avoid hypothermia and cold stress. 7. Monitor vital signs and observe for rash. 8. After transfusion, continue to monitor vital signs and check umbilical cord for bleeding or signs of infection.

Submitted By: Genorga, Christian M. Genorga, Mariah Christine Micah M. Paz, Pia B. Pinlac, Menchie S. Zantua, Frances Jane P. Submitted to: Ms. Pamela Dumagas RN. MAN