Hyperbilirubinemia

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



 

• 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