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    Hyperbilirubinemia of The Newborn-Nicu

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    Ramina Hiponia
    This document discusses hyperbilirubinemia, or jaundice, in newborns. It begins by defining hyperbilirubinemia as an excess of bilirubin in a baby's blood. It then lists risk factors for jaundice like prematurity or mothers with diabetes. The document details the pathophysiology of bilirubin breakdown and excretion. It describes different causes of newborn jaundice like breastfeeding difficulties or breastmilk components. The document outlines signs, assessments, complications like brain damage, and treatments for hyperbilirubinemia such as phototherapy, hydration, or exchange transfusions. Nursing considerations are also reviewed.

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    Hyperbilirubinemia of The Newborn-Nicu

    Uploaded by

    Ramina Hiponia
    204 views4 pages
    This document discusses hyperbilirubinemia, or jaundice, in newborns. It begins by defining hyperbilirubinemia as an excess of bilirubin in a baby's blood. It then lists risk factors for jaundice like prematurity or mothers with diabetes. The document details the pathophysiology of bilirubin breakdown and excretion. It describes different causes of newborn jaundice like breastfeeding difficulties or breastmilk components. The document outlines signs, assessments, complications like brain damage, and treatments for hyperbilirubinemia such as phototherapy, hydration, or exchange transfusions. Nursing considerations are also reviewed.

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    Neonatal Hyperbilirubinemia

    Original Title

    Hyperbilirubinemia of the Newborn-Nicu

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    This document discusses hyperbilirubinemia, or jaundice, in newborns. It begins by defining hyperbilirubinemia as an excess of bilirubin in a baby's blood. It then lists risk factors for jaundice like prematurity or mothers with diabetes. The document details the pathophysiology of bilirubin breakdown and excretion. It describes different causes of newborn jaundice like breastfeeding difficulties or breastmilk components. The document outlines signs, assessments, complications like brain damage, and treatments for hyperbilirubinemia such as phototherapy, hydration, or exchange transfusions. Nursing considerations are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    204 views4 pages

    Hyperbilirubinemia of The Newborn-Nicu

    Uploaded by

    Ramina Hiponia
    This document discusses hyperbilirubinemia, or jaundice, in newborns. It begins by defining hyperbilirubinemia as an excess of bilirubin in a baby's blood. It then lists risk factors for jaundice like prematurity or mothers with diabetes. The document details the pathophysiology of bilirubin breakdown and excretion. It describes different causes of newborn jaundice like breastfeeding difficulties or breastmilk components. The document outlines signs, assessments, complications like brain damage, and treatments for hyperbilirubinemia such as phototherapy, hydration, or exchange transfusions. Nursing considerations are also reviewed.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Some key takeaways are that hyperbilirubinemia or jaundice is common in newborns and can be caused by various factors like breastfeeding difficulties or physiological immaturity. It is important to monitor bilirubin levels and treat any underlying causes to prevent potential brain damage.

    Risk factors for jaundice include being born between 34-36 weeks gestation, having a sibling who was jaundiced, maternal diabetes or Rh disease, problems with breastfeeding or nursing, and certain genetic conditions.

    Causes of jaundice appearing within the first 24 hours include hemolytic diseases like Rh or ABO incompatibility, infections like TORCH or malaria, and genetic conditions like G6PD deficiency.

    Hyperbilirubinemia in the Newborn

    What is hyperbilirubinemia in the newborn?

    Hyperbilirubinemia happens when there is too much bilirubin in babys blood. Bilirubin is
    made by the breakdown of red blood cells. Its hard for babies to get rid of bilirubin. It can build
    up in their blood, tissues, and fluids. Bilirubin has a color. It makes a babys skin, eyes, and
    other tissues to turn yellow (jaundice). Jaundice may first appear when baby is born. Or it may
    also show up any time after birth.

    Risk factors for jaundice

    About 6 in 10 full-term newborns get jaundice. So do 8 in 10 premature babies. Babies


    born to mothers with diabetes or Rh disease are more likely to have this condition.

    jaundice within first 24 hrs of life


    a sibling who was jaundiced as neonate
    unrecognized hemolysis
    non-optimal sucking/nursing
    deficiency of G6PD
    infection
    cephalhematoma /bruising
    E - East Asian/North Indian NJ

    Pathophysiology
    The majority of bilirubin is produced from the breakdown of Hb into unconjugated bilirubin (and
    other substances). Unconjugated bilirubin binds to albumin in the blood for transport to the liver,
    where it is taken up by hepatocytes and conjugated with glucuronic acid by the enzyme uridine
    diphosphogluconurate glucuronosyltransferase (UGT) to make it water-soluble. The conjugated
    bilirubin is excreted in bile into the duodenum. In adults, conjugated bilirubin is reduced by gut
    bacteria to urobilin and excreted. Neonates, however, have less bacteria in their digestive tracts,
    so less bilirubin is reduced to urobilin and excreted. They also have the enzyme -
    glucuronidase, which deconjugates bilirubin. The now unconjugated bilirubin can be reabsorbed
    and recycled into the circulation. This is called enterohepatic circulation of bilirubin.

    Causes hyperbilirubinemia in the newborn

    Breastfeeding failure jaundice


    Many babies dont breastfeed well at first. This causes breastfeeding failure jaundice. Not
    feeding well makes your baby dehydrated. It also causes your baby to urinate less. This makes
    bilirubin build up in your babys body. Babies born between weeks 34 to 36 of pregnancy are
    more likely to get this problem. These babies often dont have the coordination and strength to
    breastfeed well. But this condition is also common in full-term newborns. It usually gets better
    once a baby learns how to breastfeed well.

    Breastmilk jaundice
    About 1 in 50 breastfed babies get jaundice. This happens during their first week of life. It peaks
    at about 2 weeks of age. It can last 3 to 12 weeks. This issue may be caused by a substance in
    breastmilk. This substance may increase how much bilirubin the baby's body can reabsorb.

    Physiologic jaundice
    Etiology
    1. Decreased RBC survival 90 days, increased RBC vol /Kg, polycythemia of NB
    2. Poor hepatic uptake due to immature liver- decreased ligandin or Y- protein
    3. Poor conjugation due to enzyme deficiency- UDPG-T activity
    4. Increased enterohepatic circulation due to - High level of intst beta-glucoronidase - delayed
    colonization by bacteria - Decreased gut motility
    5. Decreased hepatic excretion of bilirubin

    During the first few days of life, babies arent able to get rid of much bilirubin. This type
    of jaundice happens as a response to a babys reduced ability to remove bilirubin.
    Seen both in term and preterms
    Self limiting
    Develops after 24 hours
    Peaks by day 4- 5 in terms and day 7-8 in preterms
    Peak levels -12mg/dl in term & 15mg/dl in preterm
    Gradually subsides by 10-14 days
    No Treatment necessary

    PATHOLOGICAL JAUNDICE
    Suspect if..
    Jaundice in first 24 hours
    Rise of >5mg/24 hours or 0.5 mg/dl/hr
    Jaundice beyond physiological limits
    Conjugated bilirubin- >2mg or 20% of total
    Beyond 2 weeks
    Signs of underlying illness ++

    Causes of jaundice
    Appearing within 24 hours of age
    First 24 hours. This type of jaundice is often serious. Your child will likely need treatment right
    away.
    Hemolytic disease of NB : Rh, ABO
    Infections: TORCH, malaria, bacterial
    G6PD deficiency

    Appearing between 24-72 hours of life


    Second or third day. This is often physiologic jaundice. Sometimes it can be a more serious type
    of jaundice.
    Physiological
    Sepsis
    Polycythemia
    Intraventricular hemorrhage
    Increased entero-hepatic circulation

    After 72 hours of age


    Toward the end of the first week. This type of jaundice may be from an infection.
    In the second week. This is often caused by breastmilk jaundice.
    Sepsis
    Cephalhaematoma
    Neonatal hepatitis
    Extra-hepatic biliary atresia
    Breast milk jaundice
    Metabolic disorders (G6PD).

    What are the symptoms?


    If a newborn has jaundice, his or her skin and the white part of the eyes will look yellow. The
    yellow color shows up first in the baby's face and chest, usually 1 to 5 days after birth.
    A baby whose bilirubin level is high may:
    Get more yellow.
    Be sluggish and not suck well.
    Be cranky or jittery.
    Arch his or her back.
    Have a high-pitched cry.
    A high bilirubin level can be dangerous. Make sure to call a doctor right away if your baby has
    any of these symptoms.

    Assessment
    1)HistoryAntenatal Drugs ,Trauma Family H/O of jaundice Liver disease, delayed feeding ,
    Sepsis Sibling jaundice , Splenectomy in family

    2. General exam
    Cramers Index
    1.Face-4-6 mg/dl
    2.Chest &Upper trunk 8-10 mg/dl
    3.Lower abdomen,thigh-12 -14mg/dl
    4.Forearms &lower legs -15 -18 mg/dl
    5.Palms & sloes->15-20 mg/dl

    Examine
    Gestation age-preterm, IUGR Cephalhematoma, bruising Pallor-hemolytic anemia
    Patechiea -sepsis, erythroblastosis, cong infections HSM-hemolytic anemia, infections
    Evidence of hypothyroidism, infections

    3) Lab investigations 1. Hemoglobin, PCV with peripheral smear 2. Total Bilirubin (Total / Direct
    & Indirect) - >12 mg /<24hr - <12 mg/ >24 hr 3. Bilirubin level Special tests TORCH titres -
    Thyroid function tests Metabolic work up - Sepsis screen USG / X ray abdomen Blood
    group and Rh typing Reticulocyte count

    Complications of hyperbilirubinemia in newborn?


    High levels of bilirubin can travel to your babys brain. This can cause seizures and brain
    damage. This is called kernicterus. If untreated, hyperbilirubinemia can result to kernicterus or
    the deposition of bilirubin in the brain. Usually occurs if the bilirubin levels are 25mg/dl or higher
    in term infants . Toxicity starts at 8-12 mg/dl in sick or low birth weights.

    Clinical Features of Kernicterus ACUTE FORM


    Phase 1(1st 12 days): poor sucking, stupor, hypotonia, seizures
    Phase 2 (middle of 1st wk): hypertonia of extensor muscles, opisthotonos, retrocollis, fever
    Phase 3 (after the 1st wk): hypertonia (hypotonia in Spitzer)

    CHRONIC FORM
    First year: hypotonia, active deep tendon reflexes, obligatory tonic neck reflexes, delayed motor
    skills
    After 1st yr: movement disorders (choreoathetosis, ballismus, tremor), up ward gaze,
    sensorineural hearing loss

    Management
    Treatment will depend on your childs symptoms, age, and general health. It will also depend on
    how severe the condition is.

    Phototherapy
    Phototherapy - Primary treatment - infant is unclothed and is exposed to 20 watt daylight or blue
    fluorescent light at 30 inches.
    . Principle Bilirubin absorbs light maximally in the blue range (420470 nm). Phototherapy
    detoxifies bilirubin by converting it to photoproducts that are less lipophilic than bilirubin and that
    can then be excreted without further metabolism

    Side effects of phototherapy Increased insensible water loss: Frequent Breast feeding. Loose
    green stools: weigh often and compensate with breast milk. Skin rashes: Harmless, no need to
    discontinue phototherapy. Bronze baby syndrome: occurs if baby has conjugated
    hyperbilirubinemia. If so, discontinue phototherapy. Hypo or hyperthermia: monitor temperature
    frequently.

    Fiber optic blanket


    A fiber optic blanket is another form of phototherapy. The blanket it put under your baby. It may
    be used alone or with regular phototherapy.

    Exchange transfusion
    Management Double volume exchange transfusion -160-180 ml/kg - the quickest way of
    clearing the bilirubin from circulation. It is still the most effective and reliable method to reduce
    serum bilirubin . The procedure involves the incremental removal of the patient's blood and
    simultaneous replacement with fresh donor blood, saline or plasma.

    Phenobarbital given to mothers at 30-60 mg/kg/day 2 to 3 wks prior to delivery or to infants at 5


    mg/kg/day after birth is effective in reducing neonatal jaundice.

    Hydration with breastmilk


    The American Academy of Pediatrics says that you should keep breastfeeding a baby with
    jaundice. If your baby is dehydrated from light therapy, you may need to supplement with
    pumped breast milk or formula. You may also need to do this if your baby has lost too much
    weight.

    Treating any underlying cause of the condition this may include treating an infection.

    Nursing considerations of Hyperbilirubinemia


    Assessment:
    observing for evidence of jaundice at regular intervals. Jaundice is common in the first week of
    life and may be missed in dark skinned babies Blanching the tip of the nose

    Nursing diagnosis
    See the high risk infant plan of care.:
    Body T., risk for imbalanced T. related to use of phototherapy
    Fluid volume, risk for deficient related to phototherapy
    Interrupted family process related to situational crisis, re hospitalization for the therapy. NJ -

    The goals of planning


    Infant will receive appropriate therapy if needed to reduce serum bilirubin levels.
    Infant will experience no complications from therapy.
    Family will receive emotional support
    Family will be prepared for home phototherapy (if prescribed)

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