Hyperbilirubinemia and Phototherapy

Introduction

• Presenter: Meris from Level Up RN
• Topic: Hyperbilirubinemia and Phototherapy
• Resource: Level Up RN maternity flashcards

Hyperbilirubinemia

• Definition: Higher than expected levels of bilirubin in the blood
• Identification: Diagnosed through jaundice (yellowing of skin, eyes, mucous membranes)
• Pathophysiology: Breakdown of red blood cells increases bilirubin levels

Types of Jaundice

• Physiologic Jaundice:

  • Common, mild, transient
  • Due to immature liver
  • Begins on day 2-4, peaks on day 4-5, resolves within 2 weeks
  • Never occurs within the first day of life

• Pathologic Jaundice:

  • Abnormal, serious
  • Occurs within the first day of life
  • Caused by hemolysis due to maternal-fetal blood type incompatibility (ABO incompatibility)
  • Rapid rise in bilirubin levels
  • Requires immediate attention

Clinical Signs

• Jaundice in skin, eyes, mucous membranes
• Measured with a light meter on the baby’s skin
• Determines risk levels (low risk, low intermediate risk, etc.)

Labs and Diagnostics

• Bilirubin levels > 5 mg/dL is concerning
• Typically check blood levels if transcutaneous reading is high

Treatment for Hyperbilirubinemia

• Phototherapy: Using light to break down bilirubin
• Increased Frequency of Breastfeeding: Promotes bilirubin excretion through stool
• Blood Exchange Transfusion: In cases of pathologic jaundice

Complications

• Kernicterus: Brain damage caused by unconjugated bilirubin crossing the blood-brain barrier
  • Symptoms: Cerebral palsy, seizures, hearing loss, cognitive and hearing impairment
  • Nursing Care: Monitor jaundice start time, provide care during phototherapy, educate parents to feed baby often

Phototherapy Nursing Care

• Baby should wear just a diaper and eye protection
• No lotion on baby’s skin (risk of burns)
• Key Points to Monitor:
  • Turn baby every 2 hours to prevent pressure injuries
  • Monitor baby’s temperature and hydration status
  • Regularly check bilirubin levels (every 6-12 hours)
  • Parents can hold baby if using bili blanket
  • Ensure all physiological needs are met