Newborn Jaundice

Presentation by: Jennifer Ulmer, RN, IBCLC

May 2, 2011

Newborn JaundiceOccurs in 60% of term newborns

and 80% of premature newborns (AAP, 2010).

Severe hyperbilirubinemia in 8-10%

Bilirubin is a neurotoxic bile pigment made when red blood cells breakdown.

Usually harmless and peaks in the first week .

Study’s show:Important risk factors most frequently

associated with severe hyperbilirubinemia are:breastfeeding,

gestation below 38 weeks, significant jaundice in a previous

sibling, jaundice noted before discharge. Newman TB, Xiong B, Gonzales VM, Escobar GJ. (2000). Prediction and prevention of

extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med.;154 :1140 –1147.

40. Maisels MJ, Kring EA. (1998). Length of stay, jaundice, and hospital readmission. Pediatrics. 101 :995 –998.

Neonatal Jaundice

“Screening is a key intervention in the prevention of acute bilirubin encephalopathy and kernicterus.

Kernicterus is the chronic and irreversible bilirubin encephalopathy, and it is a virtually preventable disorder.” (Association of Women’s Health, Obstetric & Neonatal Nursing, 2010)

Development of Kernicterus

Early phase of acute bilirubin encephalopathy, severely jaundiced infants become lethargic and hypotonic and suck poorly.

Intermediate phase is characterized by:◦moderate stupor,

◦ irritability, ◦hypertonia ◦ fever and high-pitched cry, ◦drowsiness◦ hypertonia manifested by backward

arching of the neck (retrocollis) and trunk (opisthotonos) American Academy of Pediatrics (2004). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia, Pediatrics, PEDIATRICS Vol. 114 pp. 297-316

Jaundice

The best practice is documentation of total serum bilirubin before discharge from the hospital for accurately assessing risk of hyperbilrubinemia.(AAP, 2004)

All bilirubin levels should be interpreted according to the infant’s age in hours. An established protocol, (AAP, 2004) like at 24 hours of age, then p.r.n. is recommended.

“Transcutaneous Bilirubinmeter: A way to ‘halve the heel pricks’”

Hartshorn & Buckmaster, 2010

Phototherapy

The goal of this therapy is to clear theConcentration of circulating bilirubin or keep it from increasing.

Phototherapy does this by using light energy to change the shape of and structure of the bilirubin, so the molecules can be excreted.

This treatment has made exchange transfusions very rare.

(Maisels & McDonaugh, 2008)

Nursing Research: Mother’s Experiences – what does mother feel if baby has hyperbilirubinemia?Physical & emotional exhaustionFeeling robbedDistressed by baby’s appearanceLoss of controlMaternal vigilanceFeeling discountedFamily impactSupportive environment (Bethauer & Carey, 2010)

Nursing ResearchNurses should provide parents with

information about newborn jaundice. Mother’s educational experience “everyone has different opinion” “it’s somehow my fault”

“knowing now what I would do differently if I have another baby”(Bethauer & Carey, 2010)

A Handout for Parents Page 1

Hand out for Parents Page 2

References American Academy of Pediatrics (1994). Provisional committee for quality

Improvement and subcommitee on hyperbilirubinemia in the healthy term newborn. Pediatrics, 94, 558-565.

Association of Women’s Health, Obstetric and Neonatal Nursing, (2010). Universal screening for hyperbilirubinemia. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39, 131-132.

Brethauer, M. & Carey, L. (2010). Mother’s experiences with neonatal jaundice. Maternal Child Nursing, 35 (1), 9-14.

Hartshorn, D. & Buckmaster, A. (2010). ‘Halving the heel pricks’: evaluation of a neonatal jaundice protocol incorporating the use of transcutaneous bilirubinmeter. Journal of Paediatrics and Child Health, 46, 595-599.

Maisels, M. J. & McDonagh, A. (2008). Phototherapy for neonatal jaundice. New England Journal of Medicine, 358, 920-928.

American Academy of Pediatrics (2004). Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia, Pediatrics, PEDIATRICS Vol. 114 pp. 297-316

Newman TB, Xiong B, Gonzales VM, Escobar GJ. (2000). Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med.;154 :1140 –1147.

40. Maisels MJ, Kring EA. (1998). Length of stay, jaundice, and hospital readmission. Pediatrics. 101 :995 –998.