Neonatal Jaundice/ Lcterus Neonatrum Hyper Bilirubinemia, Types & Causes, Assessment and Management, (by GS India Nursing).

Definition:- Jaundice as defined as yellowish discoloration of (first face), skin, mucus membrane, sclera, and nails, beds due to increase level of bilirubin in blood.

Jaundice of three types:-

1. Hemolytic/ prehepatic:- Due to excess destruction of red blood cells.

2. Hepatic jaundice:- (Liver problems) Hepatic jaundice happens when your liver tissues is scarred ( knows as cirrhosis) damage aur dysfunctional.

3. Post hepatic/ obstructive jaundice:- (Excretion problem) Post hepatic obstructive jaundice, happens when Bilirubin can’t be drained properly into the bile ducts aur digestive tract because of a blockage.

Causes of Jaundice:-

  • Excessive obstruction of RBC, Malaria infection.
  • Decrease albumin in body.
  • Lack of UDPGT, ( Diphosphate Glucuronyl- transferase) enzyme.
  • Liver disease.
  • Obstruction in bile duct ( Dubin jonson syndrome).
  • Rh incompatibility (most common cause).

In pediatric, jaundice is two type:-

  • Physiological jaundice (after 24 hrs).
  • Pathological jaundice ( in 24 hours birth).

1. Physiological jaundice (95% cases) in most common.

Causes:-

  • Polycythemia in new born.
  • Increase bilirubin load on hepatic cell due to increase number of RBC as polycythemia and reduce life spen of RBC in newborn.
  • Jaundice appear in 30-72 hrs (after 24 hrs).
  • Serum bilirubin not >12 mg/dl in (terms) >15 mg in preterm.
  • Peak level at 5th day and subside in 7-10 days in terms and 15th day in preterm.
  • Sole and palm not involve.
  • No need of T/T subside automatically.
  • Need continue breast feed and hydration therapy.

2. Pathological jaundice (seen in 5% case) caused by disease condition

Causes:- Excessive destruction of RBC due to.

Hemolytic disease of newborn:-

  • Rh incompatibility (most common).
  • ABO incompatibility.
  • G6PD def.
  • Failure to excrete the conjugate Bilirubin.
  • Congenital obstruction in bile duct body.
  • Appear always in 24 hours of birth.
  • Total serum bilirubin ( TSB) >12 mg/dl terms. >15 mg/dl — preterm.
  • Increase bilirubin >5 mg/day.
  • Need treatment — phototherapy.

Assessment:-

  • Elevated bilirubin level.
  • Poor muscle stone.
  • Poor sucking reflex.
  • Lethargy.

Management:-

Phototherapy:- Treatment by exposure to baby under light.

  • Blue light is most effective (420- 480 nano meter wave length) but now-a-days white light is use to detect cyanosis as early as possible.
  • Use 4 blue light CFL + 2 white light CFL ( CFL compact fluorescent lamp).
  • Distance between light source and baby 30-45cm.
  • Light exposure time depend upon S. Bilirubin level < 10 mg/ dl.
  • Photoisomerisation.

Nurses Responsibility during Phototherapy:-

  • Eye (to prevent retina) and genital ( prevent sterility) should be covered, than exposed much as body area is possible.
  • Change in position of body every 2 hrs to expose whole body area.
  • Monitor skin temperature every 2 hrs.
  • IV fluid to prevent delay duration due to light exposure.
  • Whole body should exposed except eye and genitalia.

I hope that you liked this article……!!

Thanking you………!!

By GS India Nursing………..!!

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