Neonatal Jaundice and Nursing Intervention

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Neonatal Jaundice
Jaundice :  yellowish discoloration of skin and sclera.
-Bilirubin result from RBC break down.
Physiological jaundice
Is characterized by tinge of jaundice, it is caused by rapid destruction of excess of R.B.C which the body dose not need in atmosphere that contains more oxygen than could be obtained during prenatal life.
-Plasma level of Bilirubin rise from a normal of 1mg\dl to an average of 5-6mg\dl
between the 2nd and 4th day.
-Physiologic jaundice becomes evident between the 3rd and 5th day of life and last for about one week. This is a normal process and is not harmful to the body.
– Hb break down —– indirect bilirubin(fat soluble) —— direct bilirubin(water soluble).
– The danger of hyperbilirubinemia is brain damage (kernicterus) which occur due to precipitation of indirect bilirubin in the basal gangilia.
Assessment of neonatal jaundice

- Depends on:
1-Time of onset————-if earlier more dangerous.
2-Rate of increase.———if more than 0.5\dl\hour is significant.
3-Maturity of baby.——–if premature more dangerous.
4-Body weight.————–if low birth weight more dangerous.
Pathological jaundice
-Require immediate treatment.
-Causes of pathological jaundice:-
1-Hemolytic disease e.g :Rh and ABO incompatibility.
2-Non hemolytic disease e.g :infection, metabolic problem and GIT obstruction.
NOTES
-Breast feeding must be continued during treatment of pathological jaundice except in case of galactosemia.
-Breast feeding early on during the first day of life can prevent physiological jaundice from exaggeration.
Kernicterus
-When indirect bilirubin in the serum rise above certain level it deposited in the basal
gangilia and lead to brain damage.
Clinical features:
lethargy, poor sucking,opisthotonus position(arching of back),apnea and respiratory failure. Most of them usually die.
-Prevention and treatment :
by immediate treatment of hyperbilirubinemia by phototherapy or exchange
transfusion if required.

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