DEFINITION

-Hyperbilirubinemia or Neonatal Jaundice in newborn is one of the most common problems encountered in term newborns. Although up to 60 percent of the term newborns have clinical jaundice in the first week of life. Hyperbilirubinemia is a condition in which there is too much bilirubin in blood. When red blood cells breakdown, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the babys body. This is called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it causes a yellowing of the babys skin and tissues. This is called jaundice. Depending on the cause of the hyperbilirubinemia, jaundice may appear at birth or at any time afterward. General signs and symptoms are yellow eyes, skin, tiredness, fatigue, light colored stools, and dark urine. During the pregnancy, the placenta excretes bilirubin. When the baby is born, the liver of the baby must take over this function. There are several causes of hyperbilirubinemia and jaundice, including (1) Physiologic Jaundice this is normal response to the babys limited ability to excrete bilirubin in the first days of life. The manifestation of jaundice is after 24 hours (2) Pathologic Jaundice this may be related to inadequate liver function due to infection or other factors. The manifestation of jaundice is within 24 hours (3) Breast milk Jaundice about 2% of the breastfed babies develop jaundice after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration and (4) Jaundice from hemolysis jaundice may occur with the breakdown of RBCs due to hemolytic disease of the newborn (RH disease), having too many RBCs or bleeding. Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in the first 3 days after birth. In the present study of the Department of Health (DOH), 3, 278 male newborns were screened for hyperbilirubinemia. Results show that of 3, 278, 186 screened to have a positive result. Of the 186, 65 boys had a confirmatory testing, 45 were confirmed to have hyperbilirubinemia and 20 had normal results. In the Philippines, there is a prevalence rate of 4.5% to 25.7%. This study reveals an incidence of 3.9% among male Filipinos.

SIGNS AND SYMPTOMS

The list of signs and symptoms mentioned in various sources for Hyperbilirubinemia includes the 15 symptoms listed below: Yellow eyes Yellow skin Anaemia Enlarged spleen Yellow eyes Yellow skin Light coloured stools Dark urine

ANATOMY AND PHYSIOLOGY

Liver The liver is the largest glandular organ in the body; its office is to secrete bile. It is oblong and oval in shape, and occupies the position on the right side, under the lower ribs. Spleen Act as reservoir of red blood cells Sequesters the old, worn-out RBCs thereby removing them from the circulation Metabolism of carbohydrates, protein and fats Production of bile salts Detoxification of endogenous and exogenous substances Blood reservoir Excretion of adrenal cortex hormone Storage of vitamins such as Vitamin A and D

Gall Bladder A pear shaped organ located on the liver that stores bile.

Function: Stores and concentrates the (greenish liquid composed of watr, cholesterol, bile salts, electrolyte and phospholipids) produce by the liver Important in fat emulsification and intestinal absorption of fatty acids, cholesterol and other lipids Cystic Duct Short duct that joins the gall bladder to the common bile duct.

Bile can flow in both directions between the gallbladder and the common hepatic duct and the (common) bile duct.

Pancreas The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach.

Norman Anatomy of Bilirubin Production and Elimination

RBC lifespan of 120 days RBC will become fragile or prone Cellular content will be release Macrophages will phagocytized it Hemoglobin will split into Heme Iron Will go to the bone marrow for new RBC production Biliverdin Globins Breakdown into amino acids

Reduct into bilirubin (indirect, unconjugated) fat Transport to the liver with the help of albumin The liver enzyme will convert unconjugated to conjugated bilirubin The bacteria will convert conjugated bilirubin to urobilinogen That excrete with the feces and some of it in urine

PATHOPHYSIOLOGY
Predisposing Factors: 3 days old Female Preterm borderline neonate

RBC lifespan of 120 days RBC will become fragile Cellular content will be release Macrophages will phagocytized it Hemoglobin will split into Heme Iron Will go to the bone marrow for new RBC production Biliverdin Globins Breakdown into amino acids

Reduct into bilirubin (indirect, unconjugated) fat soluble Transport to the liver with the help of albumin Absence of glucuronyl transferase produced by liver Unconjugated to convert Increase unconjugated bilirubin

To the blood stream

Yellow discoloration of sclera, skin, conjunctiva

HYPERBILIRUBINEMIA

TREATMENT
Phototherapy

Phototherapy is a treatment that is done by placing a baby under a special light while the baby wears only protective eye patches and a diaper. The light is blue-green in color, and works by changing the molecule structure of bilirubin so it can be excreted in the urine and stool. It is used day and night, with frequent changing of the baby's position to expose all of the skin to the light. The physician will draw blood periodically to monitor the bilirubin levels. The fiberoptic blanket is another form of phototherapy. The blanket is placed under the baby, and used along with the phototherapy light, or it can be used on its own. The purpose of an exchange transfusion is for babies who have severe jaundice, and do not respond to any other treatments. The exchange transfusion is performed in the newborn intensive care unit of the hospital. The baby's blood is withdrawn through a vein or artery, the bilirubin and antibodies from the mother are diluted, and the blood is transferred back into the baby. This may need to be done several times until the bilirubin levels are normal. According to the University of Virginia Health System, about 2 percent of babies who are breastfed will develop jaundice after the first week of life. Some babies may develop jaundice in the first week of life if their calorie intake is inadequate, or if the baby is dehydrated. Breastfeeding is stopped for a day or two, and fed formula. Once the bilirubin levels are normal, breastfeeding can be resumed. Intravenous immunoglobulin is a protein in the blood that reduces the level of antibodies. Newborn jaundice may be caused by the difference in blood type between the mother and baby. Transferring immunoglobulin decreases the level of bilirubin in the baby's blood, and may also prevent the need for an exchange blood transfusion.

Fiberoptic Blanket

Exchange Blood Tranfusion

Stop Breastfeeding

Intravenous Immunoglobulin (IVIg)

LAGUNA STATE POLYTECHNIC UNIVERSITY STA. CRUZ CAMPUS STA.CRUZ , LAGUNA

CASE STUDY
Hyperbilirubinemia

Malla, Loymie Ann BSN II A