2. Neonatal Jaundice
• Learning Objectives:
• Define hyperbilirubinemia.
• Differentiate between physiological and
pathological jaundice.
• State causes of hyperbilirubinemia.
• Discuss the pathophysiology of
hyperbilirubinemia.
• Describe the most dangerous complication
of hyperbilirubinemia.
• List the three elements of therapeutic
management.
• Design plan of care for baby has
hyperbilirubinemia. NJ -
3. Neonatal Jaundice
(Hyperbilirubinemia)
• Definition: Hyperbilirubinemia refers to an
excessive level of accumulated bilirubin in
the blood and is characterized by jaundice, a
yellowish discoloration of the skin, sclerae,
mucous membranes and nails.
• Unconjugated bilirubin = Indirect bilirubin.
• Conjugated bilirubin = Direct bilirubin.
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5. Neonatal Jaundice
• Visible form of bilirubinemia
– Newborn skin >5 mg / dl
Occurs in 60% of term and 80% of
preterm neonates
However, significant jaundice occurs in
6 % of term babies
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7. Clinical assessment of
jaundice
Area of body Bilirubin levels
mg/dl (*17=umol)
Face 4-8
Upper trunk 5-12
Lower trunk & thighs 8-16
Arms and lower legs 11-18
Palms & soles > 15
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8. Physiological jaundice
Characteristics
• Appears after 24 hours
• Maximum intensity by 4th-5th day in term
& 7th day in preterm
• Serum level less than 15 mg / dl
• Clinically not detectable after 14 days
• Disappears without any treatment
Note: Baby should, however, be watched for
worsening jaundice.
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10. Course of physiological
jaundice
15
Bilirubin level
mg/dl
10
5 Term
Preterm
1 2 3 4 5 6 10 11 12 13
14
Age in Days
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11. Pathological jaundice
• Appears within 24 hours of age
• Increase of bilirubin > 5 mg / dl / day
• Serum bilirubin > 15 mg / dl
• Jaundice persisting after 14 days
• Stool clay / white colored and urine
staining clothes yellow
• Direct bilirubin> 2 mg / dl
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12. Causes of jaundice
Appearing within 24 hours of age
• Hemolytic disease of NB : Rh, ABO
• Infections: TORCH, malaria,
bacterial
• G6PD deficiency
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13. Causes of jaundice
Appearing between 24-72 hours of
life
• Physiological
• Sepsis
• Polycythemia
• Intraventricular hemorrhage
• Increased entero-hepatic circulation
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14. Causes of jaundice
After 72 hours of age
• Sepsis
• Cephalhaematoma
• Neonatal hepatitis
• Extra-hepatic biliary atresia
• Breast milk jaundice
• Metabolic disorders (G6PD).
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15. Risk factors for jaundice
JAUNDICE
• J - jaundice within first 24 hrs of life
• A - a sibling who was jaundiced as neonate
• U - unrecognized hemolysis
• N – non-optimal sucking/nursing
• D - deficiency of G6PD
• I - infection
• C – cephalhematoma /bruising
• E - East Asian/North Indian
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17. Therapeutic Management
• Purposes: reduce level of serum bilirubin
and prevent bilirubin toxicity
• Prevention of hyperbilirubinemia: early
feeds, adequate hydration
• Reduction of bilirubin levels: phototherapy,
exchange transfusion,
• Drugs Use of Phenobarbital promote
liver enzymes and protein synthesis.
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21. phototherapy
• In practice light is used in the white ,blue
and green>
• A dose response relationship exists .
Amount of irradiation directly propotion to
decrease serum bilirubin .
• The energy delivered to infant skin
decreased with increasing distance
between infant and light source (50cm)
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22. phototherapy
• Irradiating a large surface area is more
efficient
• Nature and character of the light source
e.g (quartz halide spotlight )
• Fibrostic light is also used in phototherapy
unit >
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23. Key point in the practical
execution of phototherapy
1- The infant should be naked except for
diaper , eye to be covered
2- distance between the skin and light
source .
3-when used spotlight , the infant is placed
in centre .
4- routinely add 10-15% extra fluid .
5- timing of follow -up S.B testing must be
indevedualized.
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24. Adverse effect of photo
therapy
• Photo therapy is associated with loose
stool .
• Increase risk of retinopathy.
• The combination of phototherapy &
increased S.B can produce DNA strand
breakage .
• Skin blood flow is increased, redistribution
of blood flow may occur – PDA is reported
in premature.
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25. Adverse effect of
phototherapy
• Hypocalcemia appears to be more
common in premature.
• Concentration of certain aminoacid may
change.
• burn.
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27. 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
Blanching the tip
babies of the nose
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28. Approach to jaundiced
baby
• Ascertain birth weight, gestation and
postnatal age
• Ask when jaundice was first noticed
• Assess clinical condition (well or ill)
• Decide whether jaundice is physiological or
pathological
• Look for evidence of kernicterus* in deeply
jaundiced NB
*Lethargyand poor feeding, poor or absent Moro's, or
convulsions
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29. Nursing diagnosis
• See the high risk infant plan of care.
Plus:
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.
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30. The goals of planning
• Infant will receive appropriate therapy if
needed to reduce serum bilirubin
levels.
o Infant will experience no complications
from therapy.
o Family will receive emotional support.
o Family will be prepared for home
phototherapy (if prescribed).
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