Newborn Jaundice PP

Newborn Jaundice

Concept of Jaundice

• Definition: Jaundice is a common and often temporary condition characterized by an elevation of serum bilirubin.

• Physiological vs. Pathological Jaundice:

  • Physiological jaundice occurs due to normal processes; pathological jaundice indicates underlying health issues.

• Bilirubin: A substance derived from the breakdown of red blood cells (RBCs). The liver is underdeveloped in newborns, making it hard to eliminate bilirubin.

• Symptoms: Yellow pigmentation appears first in the head (sclera and mucous membranes) and progresses to the thorax, abdomen, and extremities.

Extravascular Pathway for RBC Destruction

• Key organs: Liver, Bone Marrow, and Spleen.

  • Process:

    • RBCs phagocytized and lysed.

    • Hemoglobin is broken down into glucose, amino acids, iron (Fe2+), and bilirubin.

    • Amino acids and iron are recycled; bilirubin is excreted.

Hyperbilirubinemia

• Definition: Occurs when elevated bilirubin levels are present in the blood, which can be challenging for newborns to eliminate.

• Consequences: Bilirubin builds up in blood, tissues, and fluids.

• Excretion Mechanism: Bilirubin is excreted in urine and stools.

• Importance of Hydration: Vital for the elimination of bilirubin; dehydration exacerbates jaundice.

Risk Factors for Jaundice

• Increased RBC breakdown or production.

• Maternal Factors: Negative Rh factor, ABO incompatibility (Mother type O, Infant A, B, or AB).

• Other factors include:

  • Birth trauma, Anoxia, Prematurity, Induction methods (Oxytocin), infections, Hypoglycemia, Maternal diabetes, and family history of jaundice.

  • Ineffective breastfeeding and decreased liver function also contribute.

Physiological Jaundice

• Characteristics:

  • Commonly benign, observed in 40% of full-term infants.

  • Results from increased bilirubin production, shortened lifespan, and breakdown of RBCs.

  • Normal biological response of newborns, peaking by the second or third day, typically resolves in 5 to 10 days.

  • Factors influencing bilirubin levels include bruising, feeding patterns, and gastrointestinal activity.

Pathological Jaundice

• Definition: Indicates an underlying illness or disease.

• Timing: Can present before 24 hours post-birth or persist beyond 14 days.

• Symptoms: Rapid increases in bilirubin; often associated with anemia or hepatosplenomegaly.

• Potential Causes: Infection/sepsis, blood group incompatibility, RBC disorders.

Acute Bilirubin Encephalopathy

• Description: A neuro syndrome resulting from bilirubin deposits in brain cells.

• Dangerous Levels: Occurs at bilirubin levels exceeding 25 mg/dl; may cause severe cognitive impairments and movement disorders.

• Clinical Manifestations: Lethargy, poor feeding, abnormal tone, high-pitched cry, arching of body, and fever.

Kernicterus

• Definition: A chronic, irreversible condition resulting from bilirubin toxicity.

• Symptoms mimic those of encephalopathy but may also include hypotonia, severe cognitive impairments, and spastic quadriplegia.

Breastfeeding & Breast Milk Jaundice

• Breastfeeding Jaundice: Rare; bilirubin levels can rise after the first week due to dehydration from poor feeding.

• Breast Milk Jaundice: May result from high concentrations of certain fatty acids in milk, enhancing bilirubin circulation, often seen in infants aged 2-3 weeks.

• Management: Temporary cessation of breastfeeding may be necessary if bilirubin exceeds 20 mg/dl.

Nursing Assessment for Jaundice

• Detection: First noticeable on the face/mucous membranes/sclera, progressing head-to-toe.

• Testing: Blanching methods on the nose, forehead, and sternum; appropriate lighting crucial for visibility.

• Reporting: Any signs before 24 hours must be immediately reported.

• Complications: Be aware of potential hypoxia, hypothermia, hypoglycemia, and metabolic acidosis following hyperbilirubinemia.

Nursing Care

• Monitoring: Assess skin, vital signs, and bilirubin levels every 4 hours until normal levels (under 5-6 mg/dl).

• Temperature Check: Axillary temperatures every 4 hours.

• Intake and Output: Keep records of feeding, stool production, and daily weights.

• Adequate Care: Ensure hydration through regular feeds (q 2-3 hours), use lactation consultants if needed, and educate parents about treatments and stool changes.

Phototherapy

• Setup: Use eye protection for newborns, keep them undressed except for a diaper.

• Baseline Monitoring: Track vital signs and avoid lotions/ointments to prevent burns.

• Frequency: Remove newborn from therapy every 4 hours for inspections; observe for skin inflammation.

• Encouragement: Frequent feeding to combat dehydration; reposition every 2 hours to prevent skin breakdown.

• Lab Draws: Turn off bilirubin lights before drawing labs.

Observations During Phototherapy

• Monitoring for Effects: Look for skin discoloration or rashes (not serious), pressure sores, signs of dehydration, temperature fluctuations.

• Parental Interaction: Encourage parents to hold and interact with the newborn when phototherapy lights are off; bilirubin levels should decrease within 4-6 hours of treatment.

Nursing Care and Follow-up

• Transcutaneous Bilirubin Meter: A noninvasive tool to measure bilirubin levels.

• Phototherapy Options: Can be administered at home if warranted.

Discharge Instructions

• Follow-Up: Schedule within 1-2 days post-discharge.

• Feeding: Encourage frequent feedings to promote bilirubin excretion.

• Signs to Report: Advise parents to call if the baby feeds less, appears sleepier or difficult to wake, produces fewer wet diapers, or if there is noticeable yellowing extending below the belly button.