Jaundice neonatal

Click here to load reader

Embed Size (px)

Transcript of Jaundice neonatal

  1. 1. Neonatal jaundice
  2. 2. Neonatal Jaundice Learning Objectives: Define hyperbilirubinemia. Differentiate between physiological andpathological jaundice. State causes of hyperbilirubinemia. Discuss the pathophysiology ofhyperbilirubinemia. Describe the most dangerous complicationof hyperbilirubinemia. List the three elements of therapeuticmanagement. Design plan of care for baby hashyperbilirubinemia. NJ -
  3. 3. Neonatal Jaundice(Hyperbilirubinemia) Definition: Hyperbilirubinemia refers to anexcessive level of accumulated bilirubin inthe blood and is characterized by jaundice, ayellowish discoloration of the skin, sclerae,mucous membranes and nails. Unconjugated bilirubin = Indirect bilirubin. Conjugated bilirubin = Direct bilirubin. NJ -
  4. 4. NJ -
  5. 5. Neonatal Jaundice Visible form of bilirubinemia Newborn skin >5 mg / dlOccurs in 60% of term and 80% of preterm neonatesHowever, significant jaundice occurs in 6 % of term babies NJ -
  6. 6. Bilirubin Production & Metabolism NJ -
  7. 7. Clinical assessment of jaundiceArea of body Bilirubin levels mg/dl (*17=umol)Face 4-8Upper trunk 5-12Lower trunk & thighs8-16Arms and lower legs 11-18Palms & soles> 15 NJ -
  8. 8. Physiological jaundiceCharacteristics Appears after 24 hours Maximum intensity by 4th-5th day in term& 7th day in preterm Serum level less than 15 mg / dl Clinically not detectable after 14 days Disappears without any treatment Note: Baby should, however, be watched for worsening jaundice.NJ -
  9. 9. Why does physiologicaljaundice develop? Increased bilirubin load. Defective uptake from plasma. Defective conjugation. Decreased excretion. Increased entero-hepaticcirculation.NJ -
  10. 10. Course of physiological jaundice15Bilirubin level mg/dl105 Term Preterm 12 3 456 10 11 12 13 14Age in Days NJ -
  11. 11. Pathological jaundice Appears within 24 hours of age Increase of bilirubin > 5 mg / dl / day Serum bilirubin > 15 mg / dl Jaundice persisting after 14 days Stool clay / white colored and urinestaining clothes yellow Direct bilirubin> 2 mg / dlNJ -
  12. 12. Causes of jaundiceAppearing within 24 hours of age Hemolytic disease of NB : Rh, ABO Infections: TORCH, malaria,bacterial G6PD deficiencyNJ -
  13. 13. Causes of jaundiceAppearing between 24-72 hours oflife Physiological Sepsis Polycythemia Intraventricular hemorrhage Increased entero-hepatic circulation NJ -
  14. 14. Causes of jaundiceAfter 72 hours of age Sepsis Cephalhaematoma Neonatal hepatitis Extra-hepatic biliary atresia Breast milk jaundice Metabolic disorders (G6PD).NJ -
  15. 15. Risk factors for jaundiceJAUNDICE J - jaundice within first 24 hrs of life A - a sibling who was jaundiced as neonate U - unrecognized hemolysis N non-optimal sucking/nursing D - deficiency of G6PD I - infection C cephalhematoma /bruising E - East Asian/North IndianNJ -
  16. 16. Diagnostic evaluation: Normal values of unconjugated B. are0.2 to 1.4 mg/dL. Investigate the cause of jaundice. NJ -
  17. 17. Therapeutic Management Purposes: reduce level of serum bilirubinand prevent bilirubin toxicity Prevention of hyperbilirubinemia: earlyfeeds, adequate hydration Reduction of bilirubin levels: phototherapy,exchange transfusion, Drugs Use of Phenobarbital promoteliver enzymes and protein synthesis.NJ -
  18. 18. Babies under phototherapyBaby under conventional Baby under triple unit intense phototherapyphototherapy
  19. 19. Maisels chartAge in hrsSr BirthBilirubinweight (mg/dl)< 2424 4849 72 >72 2500g > 12mg%< 2500gEXCHANGE 15-19> 2500g Consider ExchangePhototherapyAll
  20. 20. Prognosis Early recognition and treatment of hyperbilirubinemia prevents severe brain damage. NJ -
  21. 21. phototherapy In practice light is used in the white ,blueand green> A dose response relationship exists .Amount of irradiation directly propotion todecrease serum bilirubin . The energy delivered to infant skindecreased with increasing distancebetween infant and light source (50cm)NJ -
  22. 22. phototherapy Irradiating a large surface area is moreefficient Nature and character of the light sourcee.g (quartz halide spotlight ) Fibrostic light is also used in phototherapyunit > NJ -
  23. 23. Key point in the practicalexecution of phototherapy1- The infant should be naked except fordiaper , eye to be covered2- distance between the skin and lightsource .3-when used spotlight , the infant is placedin centre .4- routinely add 10-15% extra fluid .5- timing of follow -up S.B testing must beindevedualized.NJ -
  24. 24. Adverse effect of phototherapy Photo therapy is associated with loosestool . Increase risk of retinopathy. The combination of phototherapy &increased S.B can produce DNA strandbreakage . Skin blood flow is increased, redistributionof blood flow may occur PDA is reportedin premature. NJ -
  25. 25. Adverse effect ofphototherapy Hypocalcemia appears to be morecommon in premature. Concentration of certain aminoacid maychange. burn. NJ -
  26. 26. NJ -
  27. 27. Nursing considerations ofHyperbilirubinemia Assessment: observing for evidence ofjaundice at regular intervals. Jaundice is common in the first week of life and may be missed in dark skinned Blanching the tipbabies of the noseNJ -
  28. 28. Approach to jaundicedbaby Ascertain birth weight, gestation andpostnatal age Ask when jaundice was first noticed Assess clinical condition (well or ill) Decide whether jaundice is physiological orpathological Look for evidence of kernicterus* in deeplyjaundiced NB*Lethargyand poor feeding, poor or absent Moros, orconvulsions NJ -
  29. 29. Nursing diagnosis See the high risk infant plan of care. Plus: Body T., risk for imbalanced T. related to use of phototherapy. Fluid volume, risk for deficient related to phototherapy. Interrupted family process related to situational crisis, re hospitalization for the therapy. NJ -
  30. 30. The goals of planning Infant will receive appropriate therapy ifneeded to reduce serum bilirubinlevels.o Infant will experience no complicationsfrom therapy.o Family will receive emotional support.o Family will be prepared for homephototherapy (if prescribed).NJ -
  31. 31. QUESTIONS? NJ -
  32. 32. Reference1- Dr. Nahed Al-Nagger2- manual of neonatal &pediatric intensive nursing course