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Jaundice in Newborns

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Lisa Lloyd

on 27 March 2014

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Transcript of Jaundice in Newborns

By Lisa Lloyd
Jaundice
What is physiological Jaundice?
Any Questions?
It is a common condition in newborns. Jaundice causes newborns to have a yellow color of the skin and whites of the eyes caused by excess bilirubin in the blood.
- Usually harmless
- Appears around 2nd or 3rd day, and peaks at day 3 or 4
-Duration of about 2 weeks
Fetal erythrocytes are short-lived and they break down rapidly after birth; the infant's liver may be unable to process the bilirubin (breakdown product of hemoglobin pigment) fast enough to prevent its accumulation in blood and subsequent deposit in body tissue.
-Human Anatomy & physiology pg 1097
Okay... So what does Jaundice really mean?
1. Should be done in adequate light.
2. Detected by blanching the skin with digital pressure
3.Jaundice begins in the face and progresses downward to the trunk and extremities.
4. Monitor breast feeding & # of voids and stools
5.Nurses should provide parents with both written and verbal education about newborn jaundice
Nursing Assessment?
1. Deficient body fluids related to inadequate fluid intake evidence by decreased wet diapers
Diagnoses and Interventions
Jaundice happens so frequently in newborns because:
•Newborns make more bilirubin than adults do since they have more turnover of red blood cells.
•A newborn baby's still-developing liver may not yet be able to remove adequate bilirubin from the blood.
•Too large an amount of bilirubin is reabsorbed from the intestines before the baby gets rid of it in the stool
Breakdown and Metabolism?
-Continuously monitor and document intake and out take of the newborn 8-12 feedings per day
-Assess infant breastfeeding, good latch, swallowing
2. Anxiety related to infant jaundice evidence by voice concerns and non verbals
-Review knowledge of the patient's family
-Set up home visit
Treatments:
Mild/Moderate:- Go away on its own by increasing the newborn's input to help increase the newborns output, 8-12 feedings a day

Severe: phototherapy

Rare: Give the infant new blood
Lead to?

Can occur if acute bilirubin causes permanent damage to the brain.
May result in:
Involuntary and uncontrolled movements (athetoid cerebral palsy)
Permanent upward gaze
Hearing loss
Intellectual impairment
Goals of treatment:
1. The main goal of treatment for unconjugated hyperbilirubinaemia is to prevent bilirubin toxicity, due to high levels
3. Reverse high levels of Jaundice
2. Relieve Parental stress

-Mother older than 25
-Asian or European background
-Preterm
-Cephalohematoma
- Male sex
-Dehydrated
-Exclusive and Partial breastfeeding

-In rare cases, if there is a problem with the baby’s digestive system, or a problem with the mom’s and baby’s blood types.
Pathological Jaundice
When the newborn has higher level of bilirubin and requires treatment to quickly remove bilirubin. This can occur in any newborn who has an exaggerated form of physiologic (normal) jaundice.
Risk Factors:
1. This exists when a mother has the blood type O (and therefore has antibodies against A and B cells) and her newborn is of blood type A or B. This may cause the newborn’s red blood cells to break down more quickly due to maternal antibodies that have leaked into the baby’s bloodstream.

2. If the mother has a Rh (Rhesus) factor negative blood type and the newborn is Rh factor positive.

-Is now very uncommon because Rh immune globulin (Rhogham) is given to mothers at risk before delivery.
Pathological Jaundice: Blood Type Incompatibility
-Yellow color of the skin and eyes
-Infant's weight
-Level of alertness (lethargic)
-Fever, vomiting
& level of risk
References
Kernicterus
The test is looking for "foreign" antibodies that are already adhered to the infant's rbcs, a potential cause of hemolysis
Antibody Tests (Coombs Test)
The direct test detects antibodies that are already bound to the surface of the red blood cells
The indirect test analyzes the unbound and circulating antibodies against a set of standardized blood cells in the serum
Phototherapy;
At its most basic, phototherapy refers to the use of light to convert bilirubin molecules in the body into water soluble isomers that can be excreted by the body. The absorption of light by normal bilirubin (4Z,15Z-bilirubin) results in the creation of 2 isomeric forms of bilirubin: structural isomers and configurational isomers. The main structural isomer of bilirubin is Z-lumirubin. The main configurational isomer of bilirubin is 4Z,15 E -bilirubin. Configurational isomerization is reversible, and structural isomerization is irreversible. Both the configurational and structural isomers of bilirubin are less lipophilic than normal bilirubin and can be excreted into bile without undergoing glucuronidation in the liver. Some of the configurational isomers of bilirubin, however, revert back to the native form after excretion into bile and can be reabsorbed via enterohepatic circulation in the gut. Structural bilirubin isomers, like Z-lumirubin, can also be excreted in the urine.
Simplified.... :)
Treatment with a florescent light. This alters the bilirubin to make the liver be able to metabolize it easier.
Alberta Health Services. (2010). Hyperbilirubinemia in full term newborn clinical assessment, public health nursing-central zone west.

Cohen, M., S.(2006). Pediatric Nursing. Jaundice in the Full-Term Newborn. 32(3). Retrieved from http://web.ebscohost.com.ezproxy.ardc.talonline.ca/ehost/pdfviewer/pdfviewer?sid=6b33883e-ca9b-412a-8f6c-b69d059bbc68%40sessionmgr115&vid=11&hid=113

David Thompson Health Region. (2009). Jaundice in the Newborn.

Duke Health Organization. (2013). Newborn Jaundice. Retrieved from http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/newbornjaundice

Evans, R., Evans, M., Brown Y., & Orshan, S,. (2010) Canadian Maternity, Newborn, & Woman’s Health Nursing

Kids Health. (2013). Jaundice in Healthy Newborns Retrieved from http://kidshealth.org/parent/pregnancy_center/newborn_care/jaundice.html#

Marieb, E., & Hoehn, K. (2010). Human Anatomy & Physiology

Medline plus. (2012). Coomb’s test. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/003344.htm

Medscape. 2012. Phototherapy for Jaundice. Retrieved from http://emedicine.medscape.com/article/1894477-overview

Turnbull, V., &Petty, J. (2012). British Journal of Midwifery. Early onset jaundice in the newborn: understanding the ongoing care of mother and baby. 20(9). Retrieved from http://web.ebscohost.com.ezproxy.ardc.talonline.ca/ehost/pdfviewer/pdfviewer?sid=6b33883e-ca9b-412a-8f6c-b69d059bbc68%40sessionmgr115&vid=11&hid=113

You tube. 2012. Retrieved from
http://emedicine.medscape.com/article/1894477-overview
http://www.dukehealth.org/health_library/advice_from_doctors/your_childs_health/newbornjaundice
Disease processes: liver impairment, metabolic disease, carrier protein deficiency, or binding site deficiencies
Kramer's Rule: approx bilirubin serum level
Sign's and symptoms:
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