Pathophysiology Paper: Hyperbilirubinemia

Jessi Crowden
For
Professor Sarah Holda
Nursing 176- Maternity Nursing
Jackson College Winter Semester
January 27, 2017
 The miracle of life and birth of a baby is an amazing and wonderful time for a family.

Modern medicine can prevent and immunize against many diseases, conditions, and issues

taking the worrying about them like we did a couple hundred years ago. There are still many

changes to a newborns systems that happen in the first few minutes through the first few days

that we can’t predict or fully prevent. Hyperbilirubinemia is one of those, defined as having too

much bilirubin in the blood (Dorland). 60% of full term infants, and 80% of preterm infants are

likely to have this condition (McKinney). Since this is a very common occurrence all babies are

assessed for this condition by looking for jaundice every 8-12 hours, after birth and parents are

educated about the significance of jaundice and what to look for after they are discharged

home. Some babies are at higher risk to develop Hyperbilirubinemia, Rh or ABO incompatibility

with their mother, delayed or poor nutritional intake, maternal diabetes or preeclampsia are

just a few of the factors that can predispose them (McKinney). Education and prevention of risk

factors is the best treatment for this condition.

Pathologic Jaundice

This type of jaundice could show up within the first 24 hour after birth and can lead to

bilirubin toxicity. Unconjugated bilirubin can cause bilirubin encephalopathy and if it is a chronic

condition can lead to Kernicterus which can actually stain the brain yellow (McKinney). This

jaundice is rare in our day and age but still carries a high infant mortality rate if it does occur.

Those that survive this may develop neurological disorders or development problems. Most

facilities have a bilirubinometer or draw labs for their transcutaneous bilirubin (TcB). If jaundice

develops in the first few days and we can start treatment right away the outcomes are better.

The TcB is compared to an infant chart that shows the appropriate levels per age in hours after
birth (McKinney). Infections, hypothyroidism, diabetic mothers, or any condition that causes

the breakdown of red blood cells resulting in high bilirubin levels are other causes of pathologic

jaundice. Rh and ABO incompatibility are the two other major players in pathological jaundice.

In both cases maternal antibodies cross the placenta and cause red blood cell damage, and

anemia (McKinney).

Physiological Jaundice

This jaundice is a developmental jaundice and doesn’t happen within the first 24 hours

after birth. Typically this appears the second or third day after birth, peaks, then begins to fall.

The infant’s liver has not developed enough to process the amount of bilirubin and typically

resolves it’s self within a few days (McKinney). Adequate feedings so the infant can pass the

bilirubin filled meconium will decrease the risk of breastmilk jaundice. Breastfeeding problems

or sleepy babies that don’t want to nurse as often as they should are at higher risk.

Treatment

Most common treatment for jaundice is phototherapy. Baby is undressed down to their

diaper and protective patches are placed on their eyes before being exposed to the “bili lights”

(McKinney). LED’s, halogen lamps, and fiber optic photo therapy blankets are also methods

used to help the bilirubin in the skin to absorb the light and turn into a water-soluble product

that can be excreted in bile or urine without having to make another trip to the liver to get

conjugated (McKinney). TSB blood draws are necessary to determine the effectiveness of the

phototherapy and if continued treatment is necessary. In rare cases phototherapy may not be

able to drop the levels quick enough and an exchange transfusion is necessary. This corrects
severe anemia by removing the bad red blood cells, incompatible maternal antibodies, and

unconjugated bilirubin.

Conclusion

With such a high rate of newborns that are at risk for hyperbilirubinemia it is a

collaborative effort to evaluate mothers at risk, education of these risks, and treatment or

prevention of the risks to lessen the chances of birthing a baby who develops jaundice.

Assessing the baby after birth, paying close attention to those who are at higher risk, starting

treatment early, and educating the parents on what to look for is the best way to prevent long

term damage.
Dorland, W. A. (2003). Dorland's illustrated medical dictionary. Philadelphia, PA: Saunders.

McKinney, E. S. (2013). Maternal-child nursing. St. Louis, MO: Elsevier/Saunders.