HYPERBILIRUBINEMIA

DEFINITION
HYPERBILIRUBINEMIA
An elevated level of the
pigment bilirubin in the blood.
A sufficient elevation of
bilirubin producesjaundice.
JAUNDICE

Yellowish discoloration of the

skin, sclerae and mucous
membrane due to accumulation
of bilirubin pigment

DEFINITION

DEFINITION
HYPERBILIRUBINEMIA IS A BIOCHEMICAL
FINDING BUT JAUNDICE IS A CLINICAL
FINDING FOR INCREASED BILIRUBIN
LEVELS IN THE BLOOD.

ETIOLOGY
HYPERBILIRUBINEMIA CAN BE CLASSIFIED AS
PHYSIOLOGIC OR PATHOLOGIC

PHYSIOLOGIC HYPERBILIRUBINEMIA
is considered benign
when jaundice occurs in a healthy baby, it is considered
physiological jaundice. Most babies have a degree of jaundice
after birth because their liver is unable to process bilirubin.
the infant with physiologicaljaundice has no other symptoms
and shows signs of jaundice after 24 hours of age

ETIOLOGY
HYPERBILIRUBINEMIA CAN BE CLASSIFIED AS
PHYSIOLOGIC OR PATHOLOGIC

PATHOLOGIC HYPERBILIRUBINEMIA

a result of an underlying disease

related to a condition other than normal newborn bilirubin being
processed slowly by an immature liver
-G6PD DEFFICIENCY
-SEPSIS
-RH INCOMPATIBILITY
appears before 24 hours of age or is persistent after day 7

COMPLICATIONS
KERNICTERUS
(BILIRUBIN ENCELOPATHY)

The term "kernicterus" refers to the yellow

staining caused by bilirubin
If the level of bilirubin is very high the substance
will
move out of the blood and collect in the brain
tissue if it is not bound to albumin (protein)
in the blood
Can lead to problems such as
brain damage and hearing loss

CLINICAL MANIFESTATION

Yellowing of the skin and the whites of the eyes is a

sign of infant jaundice that usually appears between
the second and fourth day after birth.

To check for infant jaundice, press gently on your

baby's forehead or nose. If the skin looks yellow where
you pressed, it's likely your baby has mild jaundice. If
your baby doesn't have jaundice, the skin color should
simply look slightly lighter than its normal color for a
moment.

CLINICAL MANIFESTATION
SIGNS OF SEVERE JAUNDICE:
Your baby's skin becomes more yellow
Your baby's skin looks yellow on the abdomen, arms or legs
The whites of your baby's eyes look yellow
Your baby seems listless or sick or is difficult to awaken
Your baby isn't gaining weight or is feeding poorly
Your baby makes high-pitched cries
Jaundice lasts more than three weeks

DIAGNOSTIC PROCEDURES
Blood type and testing for Rh incompatibility (Coomb's test)
Assess maternal and newborn blood type to determine if there
is a presence of ABO-incompatibility. This occurs if the newborn
has blood type A,B or AB, and the mother is type O

A skin test with a device called a transcutaneous

bilirubinometer, which measures the reflection of a special light
shone through the skin

PATHOPHYSIOLOGY

Hepatic excretory capacity is low both because of low

concentrations of the binding protein ligandin in the
hepatocytes and because of low activity of glucuronyl
transferase, the enzyme responsible for binding
bilirubin to glucuronic acid, thus making bilirubin
water soluble (conjugation).

PATHOPHYSIOLOGY
HIGH RBC COUNT IS DESTROYED
GLOBIN AND HEME IS RELEASED
HEME BROKEN DOWN INTO IRON AND PROTORPHYRIN
BROKEN DOWN INTO INDIRECT BILIRUBIN
CONVERTED BY GLUCONYL TRANSFERASE

- REMAINS INDIRECT
- BILIRUBIN PERMEATES TISSUE

EXCRETED IN FECES

DIRECT BILIRUBIN

IN CIRCULATORY SYSTEM

PATHOPHYSIOLOGY

MEDICAL TREATMENT
AND MANAGEMENT
PHOTOTHERAPY
o
o

the primary treatment for hyperbilirubinemia

refers to the use of light to convert bilirubin molecules in the body into
water soluble isomers that can be excreted by the body
These lights work by helping to break down
bilirubin in the skin
not indicated for conjugated hyperbilirubinemia

MEDICAL TREATMENT
AND MANAGEMENT

FIBEROPTIC BLANKET

MEDICAL TREATMENT
AND MANAGEMENT
EXCHANGE TRANSFUSION
o
o

most severe cases of jaundice

procedure involves slowly removing the
person's blood and replacing it with fresh donor
blood or plasma

o
o

baby's blood is replaced with fresh blood

helps increase the red blood cell count and
lower the levels of bilirubin

NURSING MANAGEMENT

Assist with Phototherapytreatment

Provide information about the types of jaundice, pathophysiological factors

and future implicationsof hyperbilirubinemia. Encourage to ask
questions;reinforce or clarify information, as needed

NURSING DIAGNOSIS

Altered skin color related to inability of the body to excrete bilirubin