Running head: HYPERBILIRUBINEMIA 1

Shelby Robison

Jackson College

NRS 211: Care of Women and Neonates

HYPERBILIRUBINEMIA 2

Abstract

This paper will help you understand more about hyperbilirubinemia and how it effects the

newborn baby. Hyperbilirubinemia continues to be one of the main concerns when caring for

newborns and has multiple causes. Long term effects are rare due to our highly effective

treatment options. All infants, especially pre-term, are at risk for developing hyperbilirubinemia.

Assessments of the skin will be made routinely, along with total serum bilirubin levels.

Screening is done on all infants in the hospital after birth. Our treatments have advanced

dramatically, but continuing education is still important.

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Hyperbilirubinemia presents as jaundice skin and is a common concern when caring for

neonates. Elevated bilirubin levels are present and are considered to be physiological or non-

physiological. Physiologic jaundice is considered normal. It is caused by transient

hyperbilirubinemia and is not present during the first 24 hours of life but appears two to three

days after birth. (McKinney, James, Murray, Nelson, & Ashwill, 2018, p. 432) Non-physiological

jaundice can be seen within the first 24 hours and is caused by destruction of red blood cells or

problems with bilirubin conjugation. Infants, especially preterm, have a higher rate of bilirubin

production than adults because their red blood cell life span is shorter. Unconjugated bilirubin is

not readily excreted, and the ability to conjugate bilirubin is limited. (Dennery, Seidman, &

Stevenson, 2001)

The most common cause of pathologic jaundice is hemolytic disease which results from

blood incompatibility between the mother and the fetus, also known as Rh incompatibility. An

Rh-negative mother forms antibodies when Rh-positive blood from the fetus enters her

circulation. These antibodies can develop in prior pregnancies, abortions, amniocentesis, or a

transfusion of Rh-positive blood. The antibodies can cross the placenta and destroy the fetal red

blood cells, causing erythroblastosis fetalis, a condition caused by agglutination and hemolysis of

fetal erythrocytes. (McKinney, James, Murray, Nelson, & Ashwill, 2018, p. 645) RhoGAM is a

Rho globulin that is given to the mother and inhibits the production of Rh-positive antibodies to

prevent erythroblastosis fetalis. ABO incompatibly also causes pathologic jaundice. Mothers

with type O blood have natural antibodies to types A and B blood. Hemolysis can occur when

these antibodies cross the placenta, but the destruction is much less severe than with Rh

incompatibility. (McKinney, James, Murray, Nelson, & Ashwill, 2018, p. 645)

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Non-physiologic jaundice is a concern because it can lead to bilirubin encephalopathy, a

condition caused by bilirubin toxicity. Kernicterus can also occur which is chronic and/or

permanent with effects of bilirubin toxicity. In kernicterus bilirubin stains the brain a yellow

color, specifically the basal ganglia, cerebellum, hippocampus, and brainstem. (McKinney,

James, Murray, Nelson, & Ashwill, 2018, p. 645) The mortality and morbidity rate of kernicterus

and bilirubin encephalopathy is high, but both of these conditions are rare. Long term

consequences when somebody survives these conditions are cerebral palsy, intellectual

impairment, hearing loss, and other neurologic and developmental problems.

Phototherapy is the standard of care for treating hyperbilirubinemia. Efficient

phototherapy will rapidly reduce serum bilirubin. (Dennery, Seidman, & Stevenson, 2001) The

bilirubin in the skin is absorbed by the light and converts into water-soluble products called

lumirubin. Lumirubin does not require conjugation by the liver and can be excreted in the bile

and urine. Exchange transfusions are only used when phototherapy cannot reduce high bilirubin

levels. Small portions of blood are removed and replaced with an equal amount of donor blood.

At the end of the procedure, roughly 85% of the red blood cells have been replaced. (McKinney,

James, Murray, Nelson, & Ashwill, 2018, p. 646)

The nurse should assess the infant’s level of jaundice at least every 8 hours by pressing

over a bony prominence and noting the color. This assessment should be done when

phototherapy lights are off. Other important nursing interventions include maintaining a neutral

thermal environment, providing optimal nutrition, protecting the eyes, enhancing response to

therapy, detecting complications, and teaching parents. (McKinney, James, Murray, Nelson, &

Ashwill, 2018, p. 646) New parents will have lots of questions, so education is the key for the

nurse!
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References

Dennery, P. A., Seidman, D. S., & Stevenson, D. K. (2001, February 22). Neonatal

Hyperbilirubinemia: NEJM. Retrieved April 16, 2020, from

https://www.nejm.org/doi/full/10.1056/NEJM200102223440807

McKinney, E. S., James, S. R., Murray, S. S., Nelson, K. A., & Ashwill, J. W.

(2018). Maternal-child nursing. St. Louis, MO: Elsevier.