ABNORMALITIES OF INFANTS

Physiologic Jaundice
The infant skin is sclera of the eyes appears noticeably yellow. This
happens because the high red blood cells count built up in utero is destroyed, heme and
globin are released.

GLOBIN – is a protein components that is reused by the body and is not a factor in this
developing jaundice.

HEME – is further broken down into iron (which is also reused and not involve in
the jaundice and PROTOPOPHYRIN.

PROTOPOPHYRIN – is the further broken down into direct bilirubin and indirect
bilirubin is a fat soluble and cannot be excreted and be converted to the direct bilirubin:
therefore it remains indirect bilirubin and as long as the buildup of indirect bilirubin
remains in the circulatory system, the red coloring of the blood cell covers the yellow tint
of the bilirubin has risen to more than 7mg/ml, however bilirubin permeates the tissue
outside the circulatory system and cause the infant to appear jaundice.

CEPHALHEMATOMA – it is a hemorrhage of the blood into the subcutaneous tissue.

 It is also a collection of blood under the periosteum of the skull bone, as bruising
in this location heals and the red blood cellshemolized, additional in indirect
bilirubin in released and can be another cause of jaundice.

HEMANGIOMAS (BIRTHMARKS)
 Are vascular tumors or lesion of the skin.
 There are also hamangionas are common and normal to the baby and it is
sometimes it fades when reaches a school age ( 6 – 12 years)
 It is also associated between childbirth/hemangiomas to the development of
childhood cancer exist.

3 types of Hemangiomas

i) NEVUS FLAMMEUS – is the muscular purple or red-dark lesion (sometimes

called a port-wine-strain because of its deep color. This type of lesion is one
common found in face and sometimes in the thighs.

ii) STRAWBERY HEMANGIOMA – refers to the elevated areas formed by

immature capillary and endothelial cells. Most are present at birth in the term
neonate although they may appear up to 2 weeks after birth.

iii) CAVERNOUS HEMANGIOMA – are dilated vascular spaces. They are

usually rise and resembled a strawberry hemangioma in appearace.
 iv) Mongolian spot – are collection of pigment cells (melanocytes) that appear as
slate gray patches across the sacrum or buttocks and possibly on the arm
and legs.

VERNIX CASEOSA – is a white cream cheese-like substance serves as a skin lubricant

in utero, usually it is noticeable on term newborn’s skin, at least in the skin folds at birth.

LANUGO APPEARS – is a fine downy hair that covers a newborn’s shoulders, back and
upper arms.

DESQUAMATION – within 24 hours after birth, the skin of most newborns has become
extremely dry. The dryness is particularly evident on palm of the hand and soles of the
feet.

MILIA – all newborns sebaceous glands are immature. At least one point white papule
(a plugged or unopened sebaceous glands) and can be found on the check or across
the bridge of the nose of almost every newborn.

ERYTHEMA TOXICUM - a new burn rash called ERYTHEMA TOXICUM and can be
appears in the first fourth days of life but may appears up to two weeks of birth. It begins
as white papule, and increase severely to become erythema by the second day, and
then disappear by the third days.

HEMORRHAGIC DISEASE OF THE NEWBORN

 It is result from the deficiency of the VIT. K.
 VIT. K is essential for the formation of prothrombin function and impaired blood
coagulation
 VIT. K is also a formed by the action of the bacteria in the intestine.
 Is a phenomenon that can occur if twins are monozygotic (identical share the
same placenta) if abnormal arteriovenous shunts occur that direct more blood to
one twin than the other twin.

NECROTIZING ENTEROCOLITIS (NEC) – it develops in approximately 5% of all

infants in intensive care nurseries. The bowel develops necrotic patches, interfering with
digestion and possibly leading to a paralytic ileus.

RETINIPANOTHY OF PREMATURITY (ROP) – an acquired ocular diseases that leads

to partial or total blindness in children, It caused vasoconstriction of the retinal blood
vessels.

PHOTOTHERAPY

 Phototherapy, or light therapy, is a form of treatment for skin conditions using

artificial light wavelengths from the ultraviolet (blue light) part of the sun’s
spectrum. In this way, light of certain wavelengths can be delivered with a higher
 intensity, but without the light of all the other wavelengths that are present in
sunlight, e.g. visible light and infrared (heat producing light).

 An infant’s liver process little bilirubin in utero because the mothers circulation
does this for an infant.

TYPES OF PHOTOTHERAPY

Specialized light (Quarts halogen) – if the baby has conversion potential of the liver
the infant is continuously exposed to specialized light (quarts halogen).

COOL WHITE DAY LIGHT or THE SPECIALIZE FLURECENT BLUE LAMP

 The light are placed 12 to 30inches above the newborns bassinets or incubator.

SPECIALIZED FIBEROPTIC (FIBEROPTIC BLANKET or BILIBLANKET)

 Also develop for infant’s newborn and are ideal for home care.
 The infant is undressed except for diaper so as much skin surface as possible to
expose the light.
 A newer innovation for hyperbilirbinemia management is the phototherapy
blanket that the baby should wrap around. Light generated by the blanket has
the same effect on bilirubinlevels are that an infant can be held for long period
without interrupting the phototherapy and eye patches are neccesary.

EXCHANGE TRANSFUSION (Intensive Phototherapy)

 In conjunction with hydration and close monitoring of serum bilirubin levels in the
preferred method of treatment in neonatal jaundice.

HOME PHOTOTHERAPY – is primarily used for decreasing physiologic jaundice rather

than that associated w/ blood incompatibility. It has advantage of allowing the
interrupted contact between the parents and newborn and therefore has the potential to
aid bonding

 The parents should know and understand the importance of the therapy to the
infant (baby) to avoid any disadvantages happened.
 The light must be a full 12 inches away from the infant to prevent burning, and
the infant must continuously wearing the patches and diaper during phototherapy
to protect retinas and ovaries or testes, and bilirubin level should be assessed
approximately every 12 hours.

OTHER TYPES OF PHOTOTHERAPY

Ultraviolet Light:
 UVB-Narrowband - treatment of psoriasis (3-5 treatments per week)
  UVB-Broadband - Treatment times for eczema / atopic dermatitis(2-3 treatments
per week)
 Fluorescent Lamp Tubes – can treat vitiligo patients

NURSING INTERVENTION:

Call Your Health Care Provider If

All jaundice and other problem about infection and abnormalities of infant, and child
should be medically evaluated and always call your doctor immidiatly if symptom
persist.

If Jaundice and other infection and abnormalities was not that severe we can just bring
the baby home, because the mother know already the home therapy

If Jaundice is not severe bring or just expose the child under the sun or the baby should
be exposing to sunlight.