AWHONN supports the recommended standard of screening for hyperbilirubinemia.
Here is a graph developed by research and used extensively in hospitals for determining when to intervene and with what follow up and treatment is indicated. This is a more colorful version than the one in the actual article above so I thought it would be more clear to read. What would a baby with a TCB (transcutaneousbilirubin) of
We use a graph with colors for the various levels compared to hours of age that correspond with intervention or followup. The AAP also recommends that nurses are given the authority to order serum level checks as the infant’s TCB level indicates.
A qualitative nursing research article provides valuable information that directs our practice helps us be more supportive and compassionate.
Educating the parents about jaundice and it’s treatment is a very important nursing role.
Here’s an educational handout developed at my hospital which I had proposed to our shared governance unit counsel which was brought to the pediatrician’s for their approval and input. During your career, if you see a missing link between your practice and a need that patient’s express either verbally or with their behavior, investigate the topic, see what other’s are doing and send in your findings to your governing counsel. Do something about it!
Important educational piece for parents with baby having phototherapy. Getting the most from the treatment is the goal.
Newborn Jaundice<br />Occurs in 60% of term newborns and 80% of premature newborns (AAP, 2010). <br />Severe hyperbilirubinemia in 8-10%<br />Bilirubin is a neurotoxic bile pigment made when red blood cells breakdown.<br />Usually harmless and peaks in the first week . <br />
Study’s show:<br />Important risk factors most frequently<br />associated with severe <br />hyperbilirubinemia are:<br />breastfeeding,<br />gestation below 38 weeks, <br />significant jaundice in a previoussibling,<br />jaundice noted before discharge.<br />Newman TB, Xiong B, Gonzales VM, Escobar GJ. (2000). Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch PediatrAdolesc Med.;154 :1140 –1147.<br />40.Maisels MJ, Kring EA. (1998). Length of stay, jaundice, and hospital readmission. Pediatrics.101 :995 –998.<br />
Neonatal Jaundice<br />“Screening is a key intervention in the prevention of acute bilirubin encephalopathy and kernicterus.<br />Kernicterus is the chronic and irreversible bilirubin encephalopathy, and it is a virtually preventable disorder.” (Association of Women’s Health, Obstetric & Neonatal Nursing, 2010)<br />
Development of Kernicterus<br />Early phase of acute bilirubin encephalopathy, severelyjaundiced infants become lethargic and hypotonic and suck poorly.<br />Intermediate phase is characterized by:<br />moderate stupor,<br />irritability, <br />hypertonia<br />feverand high-pitched cry, <br />drowsiness<br />hypertoniamanifested by backward archingof the neck (retrocollis) and trunk (opisthotonos)American Academy of Pediatrics (2004). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia, Pediatrics, PEDIATRICS Vol. 114 pp. 297-316<br />
Jaundice<br />The best practice is documentation of total serum bilirubin before discharge from the hospital for accurately assessing risk of hyperbilrubinemia.(AAP, 2004)<br />
All bilirubin levels should be interpretedaccording to the infant’s age in hours. An established protocol, (AAP, 2004) like at 24 hours of age, then p.r.n. is recommended.<br />
“TranscutaneousBilirubinmeter: A way to ‘halve the heel pricks’”<br />Hartshorn & Buckmaster, 2010<br />
Phototherapy<br />The goal of this therapy is to clear the<br />Concentration of circulating bilirubin or keep it from increasing.<br />Phototherapy does this by using light energy to change the shape of and structure of the bilirubin, so the molecules can be excreted.<br />This treatment has made exchange transfusions very rare.<br />(Maisels& McDonaugh, 2008)<br />
Nursing Research: Mother’s Experiences – what does mother feel if baby has hyperbilirubinemia?<br />Physical & emotional exhaustion<br />Feeling robbed<br />Distressed by baby’s appearance<br />Loss of control<br />Maternal vigilance<br />Feeling discounted<br />Family impact<br />Supportive environment <br />(Bethauer & Carey, 2010)<br />
Nursing Research<br />Nurses should provide parents with information about newborn jaundice. <br />Mother’s educational experience<br /> “everyone has different opinion”<br /> “it’s somehow my fault”<br /> “knowing now what I<br /> would do differently if I have <br /> another baby”<br />(Bethauer & Carey, 2010)<br />
References<br />American Academy of Pediatrics (1994). Provisional committee for quality Improvement and subcommitee on hyperbilirubinemia in the healthy term newborn. Pediatrics, 94, 558-565.<br />Association of Women’s Health, Obstetric and Neonatal Nursing, (2010). Universal screening for hyperbilirubinemia. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39, 131-132.<br />Brethauer, M. & Carey, L. (2010). Mother’s experiences with neonatal jaundice. Maternal Child Nursing, 35 (1), 9-14.<br />Hartshorn, D. & Buckmaster, A. (2010). ‘Halving the heel pricks’: evaluation of a neonatal jaundice protocol incorporating the use of transcutaneousbilirubinmeter. Journal of Paediatrics and Child Health, 46, 595-599.<br />Maisels, M. J. & McDonagh, A. (2008). Phototherapy for neonatal jaundice. New England Journal of Medicine, 358, 920-928.<br />American Academy of Pediatrics (2004). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia, Pediatrics, PEDIATRICS Vol. 114 pp. 297-316<br />Newman TB, Xiong B, Gonzales VM, Escobar GJ. (2000). Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch PediatrAdolesc Med.;154 :1140 –1147.<br />40.Maisels MJ, Kring EA. (1998). Length of stay, jaundice, and hospital readmission. Pediatrics. 101 :995 –998.<br />