Running head: HYPERBILIRUBINEMIA 1

Hyperbilirubinemia

Jeremy Coulter

Jackson College
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Hyperbilirubinemia

Hyperbilirubinemia is a condition in babies that is caused by having an “excessive

amount of bilirubin in the blood” (McKinney, James, Murray, Nelson, & Ashwill, 2013, p.

1522). McKinney et al. (2013) note that jaundice is visible when the total serum bilirubin

reaches 5 to 6 mg/dL (p. 721). It is commonly seen in babies that have suffered hemolytic

disease of the newborn resulting from mother and fetus blood incompatibility, with the most

common incompatibility being when a Rh-negative mother had Rh-positive antibodies during

pregnancy; ultimately, these antibodies cross through the placenta and destroy fetal blood cells

(McKinney et al., 2013, p. 721). “…causes of nonphysiologic jaundice include infection,

hypothyroidism, glucuronyl transferase deficiency, polycythemia, glucose-6-phosphate

dehydrogenase deficiency, and biliary atresia” (McKinney et al., 2013, p. 721). Complications

like erythroblastosis fetalis, hydrops fetalis, bilirubin encephalopathy, and kernicterus will also

develop from the continual destruction of the fetus’ red blood cells (McKinney et al., 2013, p.

721).

There are a few assessments that are done in diagnosing mothers at risk of having

children with hyperbilirubinemia. History and diagnostics tests are both used. McKinney et al.

(2013) state that an indirect Coombs test is used while the mother is pregnant to see if there are

any antibodies to the fetal blood present-if so, an amniocentesis may follow; a direct Coombs test

is used if jaundice is observed in an infant, and this test uses cord blood to verify the infant’s

blood type, with a positive Coombs test indicating that antibodies from the mother have attached

to red blood cells in the infant (p. 721). Nurses will observe for jaundice by examining for

discolorations and using transcutaneous bilirubinometers (McKinney et al., 2013, p. 721).

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Phototherapy and exchange transfusions are a couple of treatments for infants with

hyperbilirubinemia. Phototherapy involves putting an infant under lights, and “bilirubin in the

skin absorbs the light and changes into water-soluble products, the most important of which is

lumirubin” (McKinney et al., 2013, p. 721). Fluorescent lamps, halogen lamps, and LEDS can

be used as the lights (McKinney et al., 2013, p. 721). Fiberoptic phototherapy blankets can be

put over an infant and against its skin in place of bulbs, and this allows the mother to be able to

hold her baby (McKinney et al., 2013, p. 722). McKinney et al. (2013) indicate that exchange

transfusions are used when extremely high bilirubin levels need to be quickly decreased (p. 722).

“This treatment removes sensitized red blood cells, maternal antibodies, and unconjugated

bilirubin and corrects severe anemia” (McKinney et al., 2013, p. 722). Small amounts of the

infant’s blood are removed over time and replaced with donor blood, such that, “at the end of

transfusion, about 85% of the infant’s red blood cells have been replaced, and the bilirubin level

is reduced by 50%” (McKinney et al., 2013, p. 722). Rebound elevation of bilirubin may result,

and this could cause a need to do more exchange transfusions or to use phototherapy (McKinney

et al., 2013, p. 722).

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References

McKinney, E. S., James, S. R., Murray, S. S., Nelson, K. A., & Ashwill, J. W. (2013).

Maternal-child nursing. St. Louis, Missouri: Saunders.