unit 3 nursing care of a neonate Hyperbilirubinemia neonate.ppt

CHILD HEALTH NURSING I
2021 SCHEME
UNIT III
NURSING CARE OF A NEONATE
by Mrs.Rani.G.S, Msc (N), Child Health Nursing

1. HYPERBILIRUBINEMIA

2. DEFINITION
•Anexcessivelevelofaccumulatedbilirubinin
thebloodandischaracterizedbyjaundiceor
icterus,yellowishdiscolourationoftheskin,
sclerae&nails.

3. INCIDENCE
•25-50% of all term neonates
•60-80% of preterm

4. RBC destruction
Hemoglobin Globin used by body
Heme
Unconjugated bilirubin (insoluble substance bound to albumin)
In liver
Detached from albumin molecule
Glucorynyl transferase
Conjugated with glucuronic acid
Conjugated bilirubin (highly soluble substance)
Excreted into bile
BILIRUBIN METABOLISM

5. •Inintestinebacterialactionreducesthe
conjugatedbilirubintourobilinogen
•Mostofthereducedbilirubinisexcretedthrough
feces,asmallamounteliminatedthroughurine.

6. CAUSES
•Physiologicfactors–developmental
prematurity
•Inadequatebreastfeeding
•Excessproductionofbilirubin–hemolytic
disease,biochemicaldefects,bruises
•Disturbedcapacityofthelivertosecrete
conjugatebilirubin–enzymedeficiency,
bileductobstruction

7. •Combinedoverproduction&undersecretion
–sepsis
•Somediseasestates–hypothyroidism,galactosemia,
infantofadiabeticmother
•Geneticpredispositiontoincreasedproduction–native
Americans,Asians

8. TYPES
Physiologic jaundice
•Occursafter24hrsofbirth
•Notassociatedwithanypathologicdisease
•60%term,70%preterm
•Intermsubsideby4-7days
•Preterm6-14days

9. Pathologic jaundice
•Clinicaljaundice
•Occurswithin24hrs
•5%ofnewborns
•HemolysisduetoABO/Rhincompatibility,
intrauterineinfections
•Totalbilirubin>15mg/dl

10. Breast feeding associated jaundice
Inadequate breastfeeding
Decreased caloric & fluid intake
Decreased hepatic clearance of bilirubin
Jaundice
•Early onset jaundice –begins at 2 to 4 days of
age

11. Breast milk jaundice
•Lateonsetjaundice–beginsat5to7daysof
age
•Factorsinbreastmilk–pregnanodiol,fatty
acids,betaglucuronidaseetceitherinhibit
conjugationordecreaseexcretionofbilirubin

12. CLINICAL FEATURES
•Yellowish discoluration of skin, sclera or nails
•Lethargy
•Refusal to feed
•Dark colour urine & stool

13. Diagnostic evaluation
•Clinicalestimation
Skinblanchingwithdigitalpressure
Dermalzoneofjaundice

15. •Serumbilirubinlevel
Totalbilirubin->5mg/dl(physiologic),>15mg/dl
(pathologic)
Direct/conjugated–1.5to2mg/dl
•Noninvasivemethods
Ingramicterometer
Transcutaneousbilirubinometer

16. MANAGEMENT
PHARMACOLOGIC MGT
Phenobarbitone:promoteshepaticglucoronyl
transferasewhichincreasebilirubinconjugation
Metalloporphyrins:groupofdrugsinhibitheme
oxygenaseactivity,thusreducingbreakdownof
hemetobiliverdin

17. Phototherapy
•Applicationoffluorescentlightforconversionof
unconjugatedbilirubinintoconjugatedbilirubin

18. Principles of phototherapy
1.Photoisomerization:conversionofnatural
isomerofunconjugatedbilirubintolesstoxicpolar
isomerthatdiffusesintoblood&isexcretedinto
bilewithoutconjugation

19. 2. Structural isomerization:
•Conversion in the molecular structure
•Bilirubin lumirubin
•Lumirubin is rapidly excreted in bile & urine
without conjugation

20. 3.Photooxidation:
•Convertsbilirubinintosmallpolarproductsthat
areexcretedintheurine

21. Indications of phototherapy
•Bilirubinlevel>5mg/dl
•AsprophylacticphototherapyinELBW
•Hemolyticdiseaseofthenewborn

22. Types
•Special blue lamps with 420 to 460nm
•white light lamps (550-600nm)
•Double light systems

23. Procedure
•Removeclothesofbaby&keptunderlight
source
•Keepadistanceofabout45cmfromlightsource
•Covereyes&genitalareasasthereischanceto
causeretinaldamageandgonadaldamage
•Changepositionfrequentlytoexposeallbody
surfaces

24. Complications of phototherapy
•Insensiblewaterloss
•Retinaldamage
•Bronzebabysyndrome
•MutationsofDNA

25. Care of baby under phototherapy
•Keep naked except for eye patches & diaper
•Ensure maximum exposure to greatest skin area
•Change position every 2 hours
•Ensure eye patches do not occlude the nares
•Monitor body temperature regularly
•Weigh the baby daily

26. •Provideextrafluidsalongwithusual
requirementstocompensateforincreased
insensibleloss&stooling
•Ensurebreastfeedingadequately
•Changediaperas&whenrequiredtoavoidskin
excoriation
•Ensureparentalcontacts