Nursing care for infants with Neonatal Jaundice

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Neonatal Jaundice (Icterus neonatorum)

Jaundice (hyperbilirubinemia) can occur in the neonate as a result of physiologic or pathologic factors.

Nursing Assessment of Neonatal Jaundice

1. Babies born to Rh negative mothers.

2. Yellowish discoloration of the skin 2 hours after birth.

3. Persistent jaundice for 1 week (term infant) and for 2 weeks (preterm infants)

4. Jaundice below umbilicus between 24-48 h.

Lab Values (Bilirubin levels)

• Cord blood 4 mg/dL or more

• Rising by 0.5 mg/dL/h or more over a 4-8 hour period.

• Rising by rate of 5 mg/dL/day.

• Serum bilirubin 13 mg/dL or more in term newborns and 10 mg/dL or more in preterm newborns

 

Causes  of Neonatal Jaundice

• Physiological

• Rh incompatibility

• ABO incompatibility

• Intrauterine infections

• Hereditary spherocytosis

• Maternal diabetes

• Polycythemia

• Biliary atresia

• Pyloric stenosis

• Hypothyroidism

• Cephal hematoma

 

Guideline for Management (AAP)

Total serum bilirubin (TSB) mg/dL or µmol/L

Age

(Hours)

Consider Phototherapy

Phototherapy

Phototherapy

ET if fails

ET + intensive

Phototherapy

25-48

≥12 (170)

≥15 (260)

≥20 (340)

≥25 (430)

49-72

≥15 (260)

≥18 (310)

≥25 (430)

≥30 (510)

>72

≥17 (290)

≥20 (340)

≥25 (430)

≥30 (510)

 

Phototherapy for Hyperbilirubinemia

Phototherapy is an application of fluorescent light on infant’s exposed skin . Light changes indirect bilirubin into a water-soluble substance that can be eliminated by the kidney. This type of therapy, when used before bilirubin reaches toxic levels, often eliminates the need for exchange transfusion in the newborn.

 

Nursing Care of Babies Receiving Phototherapy

PRINCIPLES

NURSING RESPONSIBILITIES

• High bilirubin in the blood of newborn cause-kernicterus and irreversible brain damage.

• All newborns should be checked for signs of increasing bilirubin levels such as jaundice.

• Report if bilirubin exceeding 10mg per 100ml should be reported to the doctor.

• The skin of the infant should be exposed to light to gain the maximum effect of phototherapy

• All the clothing should be removed and turn infant frequently.

• Frequently turn the infant exposing all the different body parts to the light.

• Intense light can be damage eye tissue

• It is essential that the eyes be protected with sterile eye patches at all times when exposed to phototherapy.

• Light therapy requires several hours to take effect. Light augments the clearance of bilirubin by altering the route of excretion. Hemolytic disease may not help by phototherapy.

• Close observation of jaundice levels and blood reports of bilirubin and Hb should be maintained.

• The nurse should be aware that light bleaches the skin, removing external signs of jaundice before systemic effects are achieved.

• Any cool, bright, white light spectrum of 420-500nm to be used.

• 2-3 days exposure maximum effect. Safety precautions to be taken to prevent injury from burns and bulb breakage

 

Nursing Care of an Infant Receiving Phototherapy

1. Remove clothing to proper skin exposure.

2. Turn infant frequently to expose all skin area.

3. Record and report jaundice and blood levels of bilirubin.

4. Record and report if any change in body temperature

5. Cover and check eyes with eye patches to prevent eye injury.

- Be sure the eyes close before applying eye patch to prevent corneal irritation

- Should be loose enough to avoid pressure.

- Eye patches should be changed every 8houly and eye care is given.

6. Nurse should expect the infant’s stools to be green and the urine dark because of photo degradation products.

7. Serum bilirubin and hematocrit should be monitored during therapy and for 24 hours following therapy.

8. In case of breast milk jaundice stop breast feeding

temporarily.

9. Maintain feeding intervals to prevent dehydration.

 

Side Effects of Phototherapy

• Loose greenish stool

• Transient skin rash

• Bronze discoloration of the skin

• Late anemia

• Hyper pigmentation in dark color infants.

• Dehydration.

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