Description:

1. Elevated serum bilirubin level

2. Evaluation is indicated when serum levels are
greater than 12 mg/dL in a term newborn.
3. Therapy is aimed at preventing kernicterus,
(bilirubin >25 mg/dL) which results in
permanent neurological damage resulting
from the deposition of bilirubin in the brain
cells.
Nursing Interventions:
1. Monitor for the presence of jaundice.
a. Examine the newborns skin only in
natural light. Looking at skin & mucous
membranes.
b. Press a finger over the bony prominence
or tip of the newborns nose to press out
capillary blood from the tissue.
c. Note that jaundice starts at the head first
and spreads to the chest, abdomen,
arms, and legs, and hands and feet,
which are the last to be jaundiced.
2. Keep the newborn well hydrated to maintain
blood volume & prevent dehydration.
3. Facilitate early, frequent (every 3-4 hrs)
feeding to hasten passage of meconium and
encourage excretion of bilirubin.
4. Report the the doctor any signs of jaundice in
the first 24 hours of life and any abnormal
signs and symptoms.
5. Prepare for phototherapy, and monitor the
newborn closely during the treatment.
6. Monitor vital signs
7. Explain babys stool contains some bile that
will be loose & green.

Risk Factors:
1. RBC production
or breakdown
2. Rh or ABO
incompatibility
3. liver
functioning
4. Ineffective
breastfeeding
5. Sibling with
diagnosed
jaundice

6. Hypoglycemia
7. Hypothermia
8. Anoxia
9. Prematurity
10. Certain
medications
(maternal
ingestion of
asprin,
tranquilizer, &
sulfonamides)

Hyperbilirubinemia

Tests:
1. serum bilirubin level- check with heel
stick or transcutaneous bilirubin monitor
2. ABO incompatibility (newborn has blood
type A or B, & mom is type O)
3. Hgb and Hct
4. electrolyte levels to monitor for
dehydration d/t phototherapy
5. direct Coombs' test-> Rh + RBCs in
newborn

Signs & Symptoms:

1. Jaundice
2. Elevated serum bilirubin levels
3. Enlarged liver
4. Poor muscle tone
5. Lethargy
6. Poor sucking reflex
7. Fever
8. High pitched cry
9. If untreated, the newborn will
become hypertonic with backward
arching of the neck
shortened lifespan & breakdown of
fetal RBCs and liver immaturity

normal physiology of bilirubin

production

jaundice after 24 hr of age

physiologic jaundice
RBC disorders

blood group incompatibility or an

infection

bilirubin levels 0.5 mg/dL/hr, peaks

at >13 mg/dL

jaundice before 24 hr of age or

persistent for 7 days

pathologic jaundice