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Hyperbilirubinemia

  • Definition: Elevated serum bilirubin level that causes jaundice (yellowish skin color)

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    • Causes: Physiologic jaundice due to breakdown of fetal red blood cells and immaturity of liver enzymes that occurs after 24 hours of age; pathologic jaundice due to blood incompatibility between mother and baby or infection that occurs within 24 hours of age or lasts longer than 7 days; kernicterus due to untreated hyperbilirubinemia that causes brain damage
    • Signs and symptoms: Yellowish skin color that progresses from head to toe; yellowish sclerae (whites of eyes); lethargy; poor feeding; dark urine; pale stools; high-pitched cry; seizures
    • Assessment: Perform transcutaneous bilirubin measurement using a device that measures skin reflectance at multiple wavelengths; confirm with laboratory serum bilirubin test if abnormal; monitor vital signs and neurological status; observe for signs of jaundice; note the time that jaundice set in to determine whether physiologic or pathologic
    • Nursing interventions

    • Provide phototherapy as ordered if newborn’s bilirubin level is above 15 mg/dL before 48 hours of age or above 18 mg/dL before 72 hours of age or above 20 mg/dL at any point; place eye mask on baby, keep newborn undressed, cover genitalia; avoid applying lotions; remove newborn from phototherapy every 4 hours, remove eye mask; reposition newborn every 2 hours; bronze discoloration or rash is not a serious complication; monitor for dehydration by checking sunken fontanels and number of diapers produced per day; feed newborn frequently to promote bilirubin excretion through stool; administer IV fluids or blood transfusion if needed; educate parents on signs of hyperbilirubinemia and how to care for the baby

Questions on Hyperbilirubinemia

Correct Answer is D

Explanation

Elevated direct bilirubin level: Pathologic jaundice is caused by an excessive breakdown of red blood cells due to blood incompatibility or liver disease. This leads to an increased production of bilirubin, which is a yellow pigment that results from the breakdown of heme. Bilirubin can be either unconjugated (indirect) or conjugated (direct), depending on whether it is bound to a protein called albumin or not. Unconjugated bilirubin is not water-soluble and cannot be excreted in urine or bile. It needs to be converted to conjugated bilirubin by the liver, which is water-soluble and can be eliminated from the body. However, if the liver is damaged or overwhelmed by the amount of bilirubin, some of the conjugated bilirubin can leak back into the bloodstream and cause an elevated direct bilirubin level. • Decreased hematocrit level: Hematocrit is the percentage of red blood cells in the blood. When red blood cells are destroyed due to blood incompatibility or liver disease, the hematocrit level decreases. This can lead to anemia, which is a condition where the blood does not carry enough oxygen to the tissues. Positive direct Coombs test: A Coombs test is a blood test that detects antibodies that bind to red blood cells and cause them to clump together and be destroyed. A direct Coombs test checks for antibodies that are attached to the red blood cells of the newborn. A positive direct Coombs test indicates that there is an immune reaction between the mother’s and the baby’s blood types, which can cause hemolysis (destruction of red blood cells) and jaundice.

Correct Answer is C

Explanation

Placing the newborn on a radiant warmer during phototherapy can increase the risk of dehydration, hyperthermia, and skin burns. The newborn should be monitored for temperature and fluid balance during phototherapy and kept in a crib or bassinet with a blanket.

Observing the newborn’s urine and stool color is not a reliable way to detect jaundice. The color of urine and stool may vary depending on the hydration status, feeding type and other factors of the newborn. Moreover, urine and stool color may not change until the bilirubin level is very high.

It includes choices A and B, which are incorrect.
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