Chapter 19: Hyperbilirubinemia (Newborn)

Question 1

Hyperbilirubinemia

Answer 1

“jaundice”
-common and occurs because of the newborns immature liver (especially in preterm)
-the liver cannot conjugate the bilirubin as quickly as needed
>the excess bilirubin in the circulatory system moves into the skin, sclerae, nails, body fluids, and other body tissues, resulting in jaundice
-jaundice that appears on the second or third day of life usually peaks on day 4 and then declines on day 5

Question 2

Jaundice in Breastfeeding Newborns

Answer 2

-EARLY jaundice in breastfed newborns begins at 2 to 4 days and most likely results from decreased fluid intake and caloric intake; after the milk supply is well established, this type of jaundice resolves
-LATE jaundice in breastfed newborns begins at 4 to 7 days and can peak during the second week of life. Factors in the breast milk are thought to inhibit the conjugation or decrease the excretion of excess bilirubin. This usually resolves on its own
>what if parents told the nurse 2 days after delivery that they were going to discontinue breastfeeding because their baby was jaundiced and a friend told them it was from the breast milk?
-the nurse instructs parents about the different types of jaundice and encourages the mother to continue to breastfeed

Question 3

Signs and Symptoms

Answer 3

-visible jaundice (a yellowish discoloration) is seen at a level of 5 mg/dL within the first 24 hours of birth

Question 4

Diagnosis

Answer 4

hyperbilirubinemia is diagnosed if the serum bilirubin level is rising faster than 5 mg/dL in 24 hours; or the direct bilirubin is greater than 2 mg/dL; or in a healthy neonate the serum bilirubin concentration is greater than 15 mg/dL
>for preterm infants, “sick” infants, or those with hemolytic disease, the serum bilirubin level for hyperbilirubinemia would be lower than that of the full-term neonate

Question 5

Bilirubin Encephalopathy

Answer 5

describes the clinical findings when the serum bilirubin level is so elevated that the central nervous system is affected

• becomes lethargic, hypotonic, and has feeding difficulty
• if seen this should be useful to help prevent it from leading to kernicterus

Question 6

Kernicterus

Answer 6

at risk for this if jaundice is untreated

• if bilirubin crosses the blood-brain barrier, it can permanently damage a newborns brain
• not all newborns with bilirubin encephalopathy progress to kernicterus, and the exact level of serum bilirubin required to cause damage is not yet known
• damage caused by kernicterus can be cerebral palsy, auditory dysfunction, dental-enamel dysplasia, and upward gaze as well as intellectual and other disabilities

Question 7

Prevention

Answer 7

frequent and early feedings to stimulate the release of meconium stool by which bilirubin is excreted

Question 8

Nursing Care

Answer 8

• treatment of jaundice is based on underlying cause
• newborns who are plotted on the graph in the high risk zone on the bilirubin risk chart undergo phototherapy (bilirubin lights)

Question 9

Phototherapy

Answer 9

(bilirubin lights)
-uses daylight, cool white, blue, or “special blue” fluorescent light tubes; fluorescent lights are the most effective form of phototherapy and are placed around and above the newborn
-the level of bilirubin in the blood determines if the newborn is placed under single, double, or triple phototherapy
>fiberoptic systems (biliblanket) can also delivery phototherapy in a blanket form placed under or around the newborn

Question 10

Nursing Care for newborn undergoing Phototherapy

Answer 10

• eyes must be shielded by an opaque mask
• nurse assesses the newborns eyes often to assess for discharge or corneal irritation
• important to remove the mask during feedings so the newborn can receive visual stimulation
• newborns genital area must also be covered (use diaper)
• newborn is kept warm; the newborn is susceptible to hypothermia because of skin exposure, and the temperature needs to be monitored closely
• newborn receives proper nutrition to ensure the clearance of bilirubin; feed child as often as q 2 hours

Question 11

Medical Care

Answer 11

other treatment for hyperbilirubinemia may include hydration with an electrolyte solution if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine, or limited urine output and irritability