Neonatal hyperbilirubinemia pediatric nursing

Hyperbilirubinemia is a condition where bilirubin is increases in body.
Etiology
Bilirubin production
Defective uptake of bilirubin
Pathology and bilirubin metabolism
Heme oxygenase bilirubin reductase
MRP 2
Ligandin
Beta glucoronide
Coomb test
Nursing management
G6pd deficiency
Phototherapy
Exchange transfusion

1. HYPERBILIRUBINEMIA PRESNTED BY, PUNAM BISWAS M.SC NURSING 1 ST YEAR

2. DEFINITION ETIOLOGY CLINICAL MENIFESTATION DIAGNOSIS 01 02 04 05 OBJECTIVES 03 06 PATHOPHYSIOLOGY MANAGEMENT

3. INTRODUCTION

4. Hyperbilirubinemia refers to an excessive level of accumulated bilirubin in blood and is characterized by jaundice or icterus, a yellowish discoloration of the skin, sclera and nails . DEFINITION:

5. PREVALENCE IN WORLD WIDE Mercury is the closest planet to the Sun and the smallest one MERCURY Venus has a beautiful name and is the second planet from the Sun VENUS

6. PREVALENCE RATE OF NEONATAL JAUNDICE   https://doi.org/10.17511/ijpr.2016.i08.07 Big numbers catch your audience’s attention

7. Predischarge TB RISK FACTOR East Asian race Hemolytic disease

8. BHUTANI NOMOGRAM

9. Unconjugated Hyperbilirubinemia Conjugated Hyperbilirubinemia TYPES OF HYPERBILIRUBINEMIA

10. TYPES OF JAUNDICE

11. CAUSE OF CONJUGATED HYPERBILIRUBINEMIA

12. Viral & Alcoholic hepatitis Ischemic hepatopathy Systemic infection, Drugs and toxins  Sickle cell disease  Inherited disorders of bilirubin metabolisms (e.g.,  Dubin -Johnson syndrome) Cholelithiasis  Pancreatitis Portal adenopathy  Sphincter of Oddi dysfunction  Parasites  EHBA CAUSE OF CONJUGATED HYPERBILIRUBINEMIA

13. P O R T A L A D E N O P A T H Y

14. Impaired bilirubin conjugation Increased bilirubin production Impaired bilirubin uptake CAUSE OF UNCONJUGATED HYPERBILIRUBINEMIA

15. Decreased clearance Biliary obstruction Increased bilirubin production Decrease conjugation CAUSE OF HYPERBILIRUBINEMIA

16. CAUSES ACCORDING TO AGE <24 hrs 24 to 48 hrs >48 hrs ABO & Rh incompatibility TORCHS infection G6PD deficiency Drugs – vit K, salicylates Hereditary spherocytosis Crigler Najjar Syndrome Physiological jaundice Septicaemia Neonatal hepatitis EHBA Breast milk jaundice Gilbert Syndrome CF

17. CLINICAL MENIFESTATION

18. NOT FEELING WELL UNCONSOLLABLE CRY MORO REFLEX ABSENT OPISTHOTONUS POSITION CHANGE OF CONSCIOUSNESS

19. DIAGNOSIS

20. MODIFIED CRAMER’S RULE

21. ICTEROMETER M atching the skin colour by colour code depicted on the plastic strip

22. TRANSCUTANEOUS BILIMETER principle of computerized spectrophotometry to provide digital display of total bilirubin.

23. Direct or conjugated bilirubin G6PD measurement ETCO D irect Coombs' test Peripheral smear for RBC morphology \ Haematocrit or haemoglobin LABARATORY TEST

24. PREVENTION Universal systemic assessment before discharge Close follow up Prompt intervention where indicated

25. MANAGEMENT

26. Phototherapy Exchange transfusion Plasmapheresis PROCEDURE Phenobarbital therapy Oral calcium phosphate Metalloporphyrins IVIG MEDICAL MANAGEMENT UNCOJUGATED HYPERBILIRUBINEMIA

27. MEDICAL MANAGEMENT Phenobarbital therapy 3-8 mg/kg/day iv increase upto 12mg/kg/day Ursodeoxycholic acid 10-30mg/kg/day IVIG 1 mg/kg/day

28. During phototherapy, the infant’s skin is exposed to light in the blue-green spectrum (460-490 nm) in a way that transforms bilirubin into lumirubin , a water-soluble isomer, and reduces its toxicity by increasing its elimination in both the urine and stool.  PHOTOTHERAPY

29. An  exchange transfusion  is a  blood transfusion  in which the  patient 's  blood  or components of it are exchanged with other blood or  blood products ,  The patient's blood is removed and replaced by donated blood or blood components EXCHANGE TRANSFUSION

30. Plasmapheresis  is the removal, treatment, and return or exchange of  blood plasma   or components thereof from and to the  blood circulation . It is thus an  extracorporeal therapy , a medical procedure performed outside the body PLASMAPHERESIS

31. Phenobarbitone 5mg/kg/day in 2 devided dose orally for 3 days Clofibrate 50mg/kg single dose po OTHERS MEDICATION

32. UDCA 10 mg/kg/day Nutrition support Enteral feeding 10ml/kg/day Vitamin support Optimus vitamin A drops, 10 drops (0.3 ml; 11100 IU) daily Colecalciferol (vitamin D drops) 0.5 ml daily Vitamin K 2 mg daily COJUGATED HYPERBILIRUBINEMIA

33. Imbalanced nutrition: less than body requirements Ineffective thermoregulation Risk for infection Risk for impaired parent-infant attachment Impaired skin integrity Parental anxiety NURSING DIAGNOSIS

34. NURSING MANAGEMENT

35. COMPLICATION BIND ( bilirubin induced neurologic dysfunction) 01 Brain region typically affected include basal ganglia, cerebellum,white mater, brainstem nuclei for occulomotor and auditory function 02 KERNICTERUS

36. SUMMARY

37. CONCLUSION

38. JOURNAL Shabo SK, Gargary KH, Erdeve O. Indirect Neonatal Hyperbilirubinemia and the Role of Fenofibrate as an Adjuvant to Phototherapy. Children (Basel). 2023 Jul 10;10(7):1192. doi : 10.3390/children10071192. PMID: 37508689; PMCID: PMC10378335 Abstract Background:  One of the most prevalent illnesses in neonates that needs care and treatment is neonatal jaundice. Several drugs are used as pharmacological modalities for treating hyperbilirubinemia, like intravenous immunoglobulin, D-penicillamine, metalloporphyrin, phenobarbital, zinc sulfate and clofibrate. Previous studies suggest the usefulness of fenofibrate in the treatment of hyperbilirubinemia

39. CONT… Objectives:  The study aims at assessing the effectiveness of oral fenofibrate in the treatment of indirect neonatal hyperbilirubinemia in full-term neonates Method:  This is a quasi-experimental study that was conducted at Heevi Pediatrics Teaching Hospital in Duhok, which is located in the Kurdistan Region of Iraq . It involved term infants who had jaundice. The neonates who were eligible for the study were randomly assigned to one of two groups: the intervention group or the control group . Both groups were treated with conventional phototherapy. Fenofibrate was administered in a single oral dose of 10 mg/kg to the participants in the intervention group . Throughout the entirety of the treatment, levels of total serum bilirubin were compared and contrasted between the two groups.

40. Results:  After 12 h of treatment, a statistically significant difference ( p -value = 0.001) was seen in the serum bilirubin levels between the two groups. The difference in serum bilirubin levels became significantly progressively pronounced after 24, 48, and 72 h. The average time of discharge was 63.6 h for the intervention group and 90.9 h for the control group, and this difference was statistically significant ( p -value < 0.001) Conclusions:  The time it takes to lower high bilirubin levels in neonates may be shortened by combining conventional phototherapy with a single oral dosage of 10 mg/kg fenofibrate . Consequently, these neonates will experience a shorter hospitalization and an accelerated discharge from the hospital CONT…

41. Gupta P. IAP Textbook Of Pediatrics. Neonatal Hyperbilirubinemia. 6 th edition. 2004: 296-316 Singh M. Care of the newborn. Neonatal Hyperbilirubinemia. 8 th edition. 2013: 196-216 Sterk . Manual of neonatal care. Neonatal Hyperbilirubinemia. 6 th edition. 2020: 216-236 Hockenberry J. Wongs essential of pediatric nursing. Neonatal Hyperbilirubinemia. 3 rd edition. 2023: 296-306 Pal P. Child health nursing. Neonatal Hyperbilirubinemia. 4 th edition. 2016: 291-310 BOOKS

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