2. DEFINITION
Hyperbilirubinemia refers to an excessive
level of accumulated bilirubin in the blood
and is characterized by jaundice, a yellowish
discoloration of the skin, sclera, mucous
membranes and nails.
Unconjugated bilirubin = Indirect bilirubin.
Conjugated bilirubin = Direct bilirubin.
4. 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
9. MECHANISMS OF NEONATAL
JAUNDICE
1.Increased Bilirubin Load due to a high
hemoglobin concentration.
• The normal newborn infant
• Hemolysis
• Cephalhematoma or bruising , Polycythemia
2. Decreased Bilirubin Conjugation in the liver
• Decreased uridine glucuronyl transferase Activity
•Glucuronyl Transferase Deficiency Type 1 (Crigler
Najar Syndrome)
3. Defective Bilirubin Excretion
11. 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
12. 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
31. ❑In single volume exchange ( in severe
neonatal anemia): A suggestedrateis 15 aliquotsover 1
hour that is, 4 minuteseach cycle.
Aliqoutvolume(ml)=estimatedbloodvolumex infantweight(kg)/
numberof aliquotsin1hour = 85mlx weight(kg)It is usual y
5ml/kg
❑In double volume exchange: A suggested rate
is 30 aliquots over 2 hours that is, 4 minutes each cycle. This
is irrespective of whether the isovolumetric or push-pull
method is used.
Aliqoutvolume(ml)= estimatedbloodvolumex 2 x infantweight
(kg)/numberof aliquotsin2hours = 85mlx 2 x weight(kg)itis
usual y5ml/kg.
34. • Isovolumetric exchange- access is via an
umbilical venous catheter ( blood in) and an
umbilical arterial catheter(blood out).
Push pull method- using same catheter
that is the blood are pushed in pulled out
through the same umbilical venous
catheter.
42. ➢
➢
➢
➢
➢
Check the patients chart for signed exchanged transfusion order
Check consent form signed by parents
Ensure exchange blood unit is available in the blood bank and have it brought to area just prior
to procedure.
Obtain received amount of blood from blood bank. Double check the blood pack with another
nurse to ensure correct identification.
Equipment for umbilical catheterization must be available including:
✓
✓
✓
✓
✓
✓
✓
✓
✓
Clean equipment sterile equipment
Clean dressing trol ey, blue sterile plastic sheet to place understerile drape
IV infusion pump
Blood warmer
3.0 silk suture, sterile linen, cord tie, scalpel blade, tape measure
PPElike: masks protective goggles, sterile gown, two sets of sterile gloves, sterile green
drapes, sterile dressing, additional gauze swabs, assorted needles/5 ml syringes
heparinized saline
Unopened solutions for skin preparation(aqueous chlorhexidine)
UVC 5 F infants 1000g and <28 weeks and 3.5 F infants <1000g or >28weeks
➢ Prepare the infant for transfusion, after checking the identification band, keep NPO, Evacuate
➢
➢
➢
gastric contents through a 8G=FG feeding tube and leave on free drainage; obtain baseline vital
signs and blood pressure.
Infants > 34weeks gestation are placed on servo mode but < 34weeks are managed in isol ete.
Access for procedure: insertion of 5 FG umbilical catheterby physician to a level that al ows free
flowing withdrawal of blood
Patient should be on continuous cardiac monitoring
✓
✓
Secure the infant’s upper and lower extremities as per restraint policy
Maintain the infant’s temperature with radiant warmer on servo control, take the infant’s
temperature at least hourly or as ordered
43. ✓Standard precautions and aseptic technique should be
taken
✓The physician wil connect the umbilical catheter to the
first adaptor on the 4-ways stopcock
✓ Take a 20cc syringe from the tray, and attach to the
second adaptor on the way stopcock
✓Attach the blood administration set with extension tubing
to the third adaptor on the 4-way stopcock
✓ Connect the remaining adaptor of the 4-way stopcock to
the waste blood container and secure properly below the
table level
✓Draw pre-exchange laboratory work including dextrose
stick
✓ The nurse must observe the infant and record the amount
of blood out and amount of the blood in and time
✓ Document heart rate, respiratory and blood pressure
every 5 minutes and inform physician of any changes in
the vital signs
44. Blood Specimens
Initial or “First Out”.
□ FBC & film.
□ Blood Group, Direct Coomb's test.
□ Urea and electrolytes, calcium, SBR, total and conjugated.
□ Blood gas with PGL.
□ Coagulations profile.
□ Newborn screening test.
□Hold samples for other tests as indicated, e.g. G6PD deficiency, viral infection,
hereditary spherocytosis, metabolic studies.
Halfway Specimens
□ SBR
□ Blood gas with PGL
□ FBC/Coagulation screen if warranted
End or “Last Out” specimens
□ SBR, Urea & Electrolytes, calcium, magnesium, phosphate.
□ FBC and Cross match for possible subsequent exchange.
□ Coagulation studies.
□ Blood gas with PGL
Post Exchange
Measure serum bilirubin within 2 hours
45. NICU Exchange Transfusion Chart
Date : Aliquots (circle one):
5 ml 10 ml 20 ml
Total
volume
to be
infused:
Vital signs
Cycle Time Volume out Total
out
Volume in Total in HR RE BP T SPO2 BSL
Sample
for lab.
Medications
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Total
