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Hyperbilirubinemia Pathophysiology Paper
Hyperbilirubinemia Pathophysiology Paper
Jessi Crowden
For
Professor Sarah Holda
Nursing 176- Maternity Nursing
Jackson College Winter Semester
January 27, 2017
The miracle of life and birth of a baby is an amazing and wonderful time for a family.
Modern medicine can prevent and immunize against many diseases, conditions, and issues
taking the worrying about them like we did a couple hundred years ago. There are still many
changes to a newborns systems that happen in the first few minutes through the first few days
that we can’t predict or fully prevent. Hyperbilirubinemia is one of those, defined as having too
much bilirubin in the blood (Dorland). 60% of full term infants, and 80% of preterm infants are
likely to have this condition (McKinney). Since this is a very common occurrence all babies are
assessed for this condition by looking for jaundice every 8-12 hours, after birth and parents are
educated about the significance of jaundice and what to look for after they are discharged
home. Some babies are at higher risk to develop Hyperbilirubinemia, Rh or ABO incompatibility
with their mother, delayed or poor nutritional intake, maternal diabetes or preeclampsia are
just a few of the factors that can predispose them (McKinney). Education and prevention of risk
Pathologic Jaundice
This type of jaundice could show up within the first 24 hour after birth and can lead to
bilirubin toxicity. Unconjugated bilirubin can cause bilirubin encephalopathy and if it is a chronic
condition can lead to Kernicterus which can actually stain the brain yellow (McKinney). This
jaundice is rare in our day and age but still carries a high infant mortality rate if it does occur.
Those that survive this may develop neurological disorders or development problems. Most
facilities have a bilirubinometer or draw labs for their transcutaneous bilirubin (TcB). If jaundice
develops in the first few days and we can start treatment right away the outcomes are better.
The TcB is compared to an infant chart that shows the appropriate levels per age in hours after
birth (McKinney). Infections, hypothyroidism, diabetic mothers, or any condition that causes
the breakdown of red blood cells resulting in high bilirubin levels are other causes of pathologic
jaundice. Rh and ABO incompatibility are the two other major players in pathological jaundice.
In both cases maternal antibodies cross the placenta and cause red blood cell damage, and
anemia (McKinney).
Physiological Jaundice
This jaundice is a developmental jaundice and doesn’t happen within the first 24 hours
after birth. Typically this appears the second or third day after birth, peaks, then begins to fall.
The infant’s liver has not developed enough to process the amount of bilirubin and typically
resolves it’s self within a few days (McKinney). Adequate feedings so the infant can pass the
bilirubin filled meconium will decrease the risk of breastmilk jaundice. Breastfeeding problems
or sleepy babies that don’t want to nurse as often as they should are at higher risk.
Treatment
Most common treatment for jaundice is phototherapy. Baby is undressed down to their
diaper and protective patches are placed on their eyes before being exposed to the “bili lights”
(McKinney). LED’s, halogen lamps, and fiber optic photo therapy blankets are also methods
used to help the bilirubin in the skin to absorb the light and turn into a water-soluble product
that can be excreted in bile or urine without having to make another trip to the liver to get
conjugated (McKinney). TSB blood draws are necessary to determine the effectiveness of the
phototherapy and if continued treatment is necessary. In rare cases phototherapy may not be
able to drop the levels quick enough and an exchange transfusion is necessary. This corrects
severe anemia by removing the bad red blood cells, incompatible maternal antibodies, and
unconjugated bilirubin.
Conclusion
With such a high rate of newborns that are at risk for hyperbilirubinemia it is a
collaborative effort to evaluate mothers at risk, education of these risks, and treatment or
prevention of the risks to lessen the chances of birthing a baby who develops jaundice.
Assessing the baby after birth, paying close attention to those who are at higher risk, starting
treatment early, and educating the parents on what to look for is the best way to prevent long
term damage.
Dorland, W. A. (2003). Dorland's illustrated medical dictionary. Philadelphia, PA: Saunders.