Bilirubin break down
RBC ——> heam & globin
Heam —> billiverdin —-> bilirubin —->albumin ——-> broken down further and excreted through the kidneys and gut
Pathological jaundice
Jaundice <24hrs or > 14/7
- ABO/rhesus incompatibility
- drugs
- infection
- CF
- biliary atresia
Physiological jaundice
Babies who higher risk
Jaundice >24hrs and <14/7
- prem
- breastfed
- race
- bruising
ABO/rhesus incompatibility
Mixed blood type and antibodies from baby to mum can cause babies body to attack own blood cells and break down RBC’s increasing bilirubin in blood
Treatment for jaundice
- phototherapy
- fluid management
- documentation
- avoiding prophylactic phototherapy
- if pathological need to treat underlying cause
- exchange transfusion
Phototherapy - how it helps
- converts bilirubin to water soluble isomers -> excreted more easily
- converts from unconjagated to conjugated
- photo -oxidation
- dose dependant on wave length
Stopping treatment
- SBR level is <50mmol/l below treatment line
- accurate plotting
- rebound 8-12hrs after stopping
- further treatment if rebounds
Nursing management
- supine
- skin exposure
- 4-6hrly temps (consider temp support)
- daily weights
- eye shield
- fluid balance (IV fluids if necessary)
- keep baby comfortable and calm
- explain and reassure parents (short breaks if on single phototherapy)
- NO creams
- SBR 4-6hrly after treatment started
- SBR 6-12hrly once level is stable or dropping
Side effects of phototherapy
Hypothermia
Hyperthermia
Skin rashes
Loose stools
Dehydration
Bonding
Risks of jaundice
Kernicterus
HDN
Anaemia
Why do babies get high jaundice
Greater production and faster breakdown of res blood cells in first few days of life
Liver filters bilirubin and excreted via urine and intestinal tract
Newborns liver is immature and often can’t remove bilirubin quick enough -> excess bilirubin
