HYPERBILIRUBINEMIA

“Jaundice “

Definition

• Yellow staining of the skin and sclerae (the whites of the eyes) by abnormally high blood levels of the bile pigment bilirubin.

• Was once called the "morbus regius" (the regal disease) in the belief that only the touch of a king could cure it.

Kinds of Jaundice

• Physiological (normal) jaundice

• Jaundice of prematurity

• Breast milk jaundice

• Blood group incompatibility (Rh or ABO

problems)

Physiological (normal) jaundice

• Occurs in 50% of newborns.

• It normally appears between 2-4 days

after birth and can last for a couple of

weeks

Jaundice of prematurity

• is common in premature babies because their livers are generally underdeveloped and can’t expel the bilirubin properly.

Breast milk jaundice

• Occur’s when there is a substance in a

mother’s milk that causes the bilirubin

level to rise.

• Generally occurs between 4-7 days after

birth and can last up till the baby is 10

weeks old

Blood group incompatibility (Rh or ABO problems)

• Is caused when a mother has a different

blood type than her baby. This however

can be avoided in some cases now by the

mother being given Rh shots while

pregnant.

Etiology

• Physiologic hyperbilirubinemia

•Undeveloped Liver

• Breast milk jaundice

• Pathologic hyperbilirubinemia due to

hemolytic disease

Other Causes

• Immune and nonimmune hemolytic anemia

• G6PD deficiency• Hematoma reabsorption• Sepsis• Hypothyroidism

Clinical Manifestation

•  Yellowish discoloration of the skin and eyes 

• 2 to 3 mg/dL (34 to 51 μmol/L) -visible on the sclera

• 4 to 5 mg/dL (68 to 86 μmol/L) - face 

• 15 mg/dL (258 μmol/L) - umbilicus 

• 20 mg/dL (340 μmol/L) - visibly jaundiced

Pathophysiology

Broken-down RBC’s

Bilirubin

Bilirubin binds with albumin (Unconjugated bilirubin)

Conjugation

The liver excretes Conjugated Bilirubin to the bile duct

Conjugated Bilirubin moved through biliary system as a component of bile to small

intestine

Immature liver

level of Unconjugated bilirubin in the

blood

Urobilinogen

Urobilinogen is excreted to feces

Reabsorb

brownish color Stool

Yellow color of sclera

Yellow color of skin from head

to toe

Diagnostic Test

• Hematocrit• Blood smear• Reticulocyte count• Direct Coombs' test• TSB and direct serum bilirubin

concentrations• Blood type and Rh group of the infant and

mother

If bilirubin concentration > 10 mg/dL (> 170 μmol/L) in preterm infants or > 18 mg/dL in term infants warrants additional testing

Medical Management

PhototherapyExchange transfusion

Nursing Care Plan

ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective:“Naninilaw angmata at balat ngbaby ko” asverbalized by themother.

Objective:•Skinappearing lightto brightyellow.•Scleraeappearingyellow.•Dark amberurine.•V/S taken asfollows:T: 36.3CR: 110RR: 30

Risk for injuryrelated toprematurity

Hyperbilirubinemia(jaundice) in theneonate is anaccumulation ofserum bilirubinabove normallevels. Onset ofclinical jaundice isseen when serumbilirubin levels are5 to 7 mg/100 dL.Physiologicjaundice occurs 3to 5 days after birthand is an increasein unconjugatedbilirubin levels thatdo not exceed 5mg/100 dL/ day.

After 7 days of nursinginterventions, the patient skin color will be normal.

Independent:•Note theinfant’s age.•Assist withphototherapytreatment.•Have the infantcompletelyundressed.•Keep the eyesand gonads covered.•Develop a systematic schedule of turning the infant.

Collaborative:•Obtain bilirubinlevel as directed.•Administerfluids as directed.

May aids in diagnosingunderlying cause inconnection withthe appearanceof jaundice.

To allow for utilization of alternate pathways for bilirubin excretion.

To expose the entire skin in phototherapy.

To protect themfrom theconstantexposure tohigh intensitylight.

Ideally every 2hours so that allthe surfaces areexposed.

To have a baseline data if the therapeuticregimen is effective.

To ensure adequatehydration.

After 7 days of nursinginterventions, the patient skin color was normal.

THANK YOU