HYPERBILIRUBINE

MIA
“Jaundice “
Definition
• Yellow staining of the skin and
sclerae (the whites of the eyes) by
abnormally high blood levels of the
bile pigment bilirubin.

• Was once called the "morbus

regius" (the regal disease) in the
belief that only the touch of a king
could cure it.
Kinds of Jaundice

• Physiological (normal) jaundice

• Jaundice of prematurity
• Breast milk jaundice
• Blood group incompatibility (Rh or ABO
problems)
Physiological (normal) jaundice

• Occurs in 50% of newborns.

• It normally appears between 2-4 days
after birth and can last for a couple of
weeks
Jaundice of prematurity

• is common in premature babies

because their livers are generally
underdeveloped and can’t expel the
bilirubin properly.
Breast milk jaundice

• Occur’s when there is a substance in a

mother’s milk that causes the bilirubin
level to rise.
• Generally occurs between 4-7 days after
birth and can last up till the baby is 10
weeks old
Blood group incompatibility (Rh or ABO
problems)

• Is caused when a mother has a different

blood type than her baby. This however
can be avoided in some cases now by the
mother being given Rh shots while
pregnant.
Etiology

• Physiologic hyperbilirubinemia
•Undeveloped Liver
• Breast milk jaundice

• Pathologic hyperbilirubinemia due to

hemolytic disease
Other Causes
• Immune and nonimmune hemolytic
anemia
• G6PD deficiency
• Hematoma reabsorption
• Sepsis
• Hypothyroidism
Clinical Manifestation
•  Yellowish discoloration of the skin and eyes 
• 2 to 3 mg/dL (34 to 51 μmol/L) -visible on the sclera

• 4 to 5 mg/dL (68 to 86 μmol/L) - face 

• 15 mg/dL (258 μmol/L) - umbilicus 
• 20 mg/dL (340 μmol/L) - visibly jaundiced
 Pathophysiology
Broken-down RBC’s

Bilirubin

Bilirubin binds with albumin

(Unconjugated bilirubin)

Conjugation Immature liver

The liver excretes Conjugated

Bilirubin to the bile duct level of
Unconjugated
bilirubin in the
Conjugated Bilirubin moved
blood
through biliary system as a
component of bile to small
intestine
 Urobilinogen Yellow color of Yellow color of
sclera skin from head
to toe

Urobilinogen is Reabsorb
excreted to feces

brownish color
Stool
Diagnostic Test
If bilirubin concentration > 10 mg/dL (> 170 μmol/L) in
preterm infants or > 18 mg/dL in term infants warrants
additional testing
• Hematocrit
• Blood smear
• Reticulocyte count
• Direct Coombs' test
• TSB and direct serum bilirubin
concentrations
• Blood type and Rh group of the infant and
mother
Medical Management

Exchange
transfusion Phototherapy
Nursing Care Plan
 ASSESSMENT DIAGNOSIS INFERENCE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for Hyperbilirubinemia After 7 days Independent:  May aids in After 7 days of nursing
“Naninilaw ang injury (jaundice) in the of nursing •Note the diagnosing interventions, the
mata at balat ng related to neonate is an intervention infant’s age. underlying cause patient skin color was
baby ko” as prematurity accumulation of s, the •Assist with in normal.
verbalized by the serum bilirubin patient skin connection with
mother. above normal color will be phototherapy the appearance
levels. Onset of normal. treatment. of jaundice.
Objective: clinical jaundice is •Have the infant  To allow for
•Skin seen when serum completely utilization of
appearing light bilirubin levels are undressed. alternate
to bright 5 to 7 mg/100 dL. •Keep the eyes pathways for
yellow. Physiologic bilirubin
jaundice occurs 3 and gonads
•Sclerae excretion.
covered.
appearing to 5 days after  To expose the
yellow. birth •Develop a entire skin in
•Dark amber and is an increase systematic phototherapy.
urine. in unconjugated schedule of  To protect them
•V/S taken as bilirubin levels that turning the infant. from the
follows: do not exceed 5 constant
T: 36.3 mg/100 dL/ day. exposure to
CR: 110 Collaborative: high intensity
RR: 30 •Obtain bilirubin light.
level as directed.  Ideally every 2
•Administer hours so that all
fluids as directed. the surfaces are
exposed.
 To have a
baseline data if
the therapeutic
regimen is
effective.
 To ensure
adequate
hydration.
THANK YOU