Hyperbilirubinemia: Nursing process (ADPIE)

Charlotte Simpson is a 4-day-old female born by spontaneous vaginal delivery at 36 weeks of gestation, weighing 6 pounds, 11 ounces, or 3034g.

At the time of discharge, Mrs. Simpson, G1P1, was breastfeeding well and Charlotte had no evidence of jaundice.

Two days later Mrs. Simpson brings Charlotte to the pediatrician’s office. She reports that Charlotte had been spending less time suckling during feedings and would fall asleep after nursing only a couple of minutes.

She says that Charlotte has been less active, and has had just one stool per day for the past two days. She also noticed that the whites of her eyes have developed a yellowish tinge.

A total serum bilirubin, or TSB, of 18.2 mg/dL confirms a diagnosis of hyperbilirubinemia and Charlotte is admitted to the pediatric unit for phototherapy. Hyperbilirubinemia refers to the increase in total serum bilirubin levels.

This often results in the deposition of bilirubin in the skin, sclera, and mucous membranes, causing a yellowish pigmentation known as jaundice.

Now, there are some risk factors that can make hyperbilirubinemia more likely to occur.

These include gestational diabetes, an ABO blood group or Rh incompatibility between mother and baby, as well as preterm birth before 37 weeks, low birth weight below 1,500 grams, and being of East Asian race.

Other factors that increase the risk of hyperbilirubinemia include genetic disorders like glucose-6-phosphate disease, as well as birth injuries like bruising or cephalohematoma, which is when blood accumulates under the scalp caused by pressure during labor.

Now, there’s two types of bilirubin: unconjugated and conjugated. Unconjugated or indirect bilirubin is a waste product that results from the breakdown of red blood cells.

Unconjugated bilirubin is later linked or conjugated with glucuronic acid to produce conjugated or direct bilirubin, which can be excreted as bile by the liver into the small intestines.

So, what’s causing the hyperbilirubinemia largely depends on whether too much bilirubin is being produced, or too little is being excreted.

Unconjugated hyperbilirubinemia in newborns occurs when there’s an increased breakdown of red blood cells or the liver is unable to conjugate all the bilirubin that is produced.