This document discusses hyperbilirubinemia, or excessive bilirubin levels in the blood. It defines bilirubin as a product of hemoglobin breakdown. It describes the different types of jaundice including physiologic, pathologic, and breastfeeding associated. Physiologic jaundice is a normal process in newborns as the liver matures. Pathologic jaundice is caused by hemolytic or nonhemolytic diseases. Breastfeeding associated jaundice can occur if breastfeeding is ineffective. The document outlines phototherapy treatment which uses blue lights to break down bilirubin, and monitoring during the process.

1. Hyperbilirubinemia
Mahdi Hemmat, RN, CCRN

2. What is it?

3. Hyperbilirubinemia
3
• Refers to an excessive accumulation of bilirubin in the blood
• Bilirubin is the end product of hemoglobin breakdown
– Total bilirubin is the combined measure of direct and indirect bilirubin
• Indirect (unconjugated) – fat soluble; not easily excreted in bile or urine;
needs to be converted to direct bilirubin by the liver in order to be
excreted
• Direct (conjugated) – water soluble; metabolized by the liver; excreted
through the bowel and bladder
• Characterized by Jaundice
• What is Jaundice?
• Visible jaundice usually occurs when serum levels are >5mg/dl

4. Hyperbilirubinemia
• Types of Jaundice
– Physiologic
– Pathologic
– Breastfeeding Associated
4

5. Physiologic Jaundice

6. Hyperbilirubinemia
• Normal process that occurs during transition from intrauterine
to extrauterine life
– Appears after 24 hours of life
– Most often self-limiting – resolving by the end of the first week of life
– Usually requires no treatment
• In the normal newborn, bilirubin typically increases over a
period of three to four days then decreases rapidly
• The increase in bilirubin may be prolonged in a preterm infant,
increasing the risk of jaundice.
• May develop in 2 to 3 days after delivery in about 50% of full-
term neonates and in 3 to 5 days in about 80% of premature
neonates
6

7. 7

8. Pathologic Jaundice

9. Hyperbilirubinemia
9
• Hemolytic disease – more bilirubin produced from breakdown
of RBCs
• Nonhemolytic disease – increased bilirubin production due to
bruising, cephalohematomas from birth, polycythemia,
swallowed blood, macrosomic infants of IDDM mothers,
liver/gallbladder disorders

10. 10

11. Breastfeeding Associated Jaundice

12. Hyperbilirubinemia
• Approximately ⅓ of healthy breastfed infants are noted to
have persistent jaundice after two weeks of age
• Appears in the first few days of life in a breastfed newborn
• Possibly due to ineffective breastfeeding practices and supply
– Decreases volume and caloric intake
– May lead to dehydration and delay passage of meconium
– Delayed stooling
12

13. Adverse Effects

14. Hyperbilirubinemia
• Potential for bilirubin encephalopathy and kernicterus
• Neurologic effects of unconjugated bilirubin in the brain may
be reversible but may also be permanent
• Neurotoxicity occurs at different thresholds and under varied
conditions
14

15. Hyperbilirubinemia
15

16. Phototherapy

17. Hyperbilirubinemia
• Treatment ordered by physician
• Blue pigmented lighting helps breakdown bilirubin
• What you need:
– Lights
– Bili meter
– Eye mask for infant
• Infant needs to spend majority of time under lights to receive
full effects – short times out for feedings is acceptable
• Eye shield needs to be in place while infant is under the lights
– eyes and surrounding skin should be checked every 4 hours
• No clothing or swaddling – only diaper is to be worn under
lights
17

18. Hyperbilirubinemia
18
• Skin assessment
• Temperature
• Light height is measured 12 inches from infant’s chest initially
• Light intensity is measured with bili meter and documented
upon admission and every 12 hours
– Level should be 17-30 for high intensity therapy
– Raise or lower lights depending on intensity reading
• Drawing labs during phototherapy?

19. 19
Questions?