Hyperbilirubinemia: Recognition, Care and Management of Term and Near-Term Infants

Objectives

What is the Problem?

Definition of Terms

Production, Metabolism, Transport and Excretion

Assessment

Practice Standard

Current Treatment

Education

Bibliography

Quiz

Main Lab Page

What is the problem?

Neonatal jaundice, hyperbilirubinemia and kernicterus are concerns of health care providers caring for neonates. Decades ago, kernicterus due to severe hyperbilirubinemia resulting from fetal-maternal Rh incompatibility (Rh positive babies for to Rh negative mothers), was a leading cause of cerebral palsy. The introduction of Rh immunoglobin (Rhogam) to prevent maternal sensitization has greatly reduced the incidence of this hemolytic disease and resulting kernicterus of the newborn.

Before the 1980s, few neonates were discharged from the hospital before three days of life, a period relatively consistent with peak bilirubin levels in the term newborn. Neonates with elevated bilirubin levels were more likely to be identified by health care professionals before discharge. As shorter hospital stays have become the norm for term (37 completed weeks of gestation) or near term (35-37 weeks of gestation) newborns, the readmission rates for dehydration and hyperbilirubinemia have increased. Of more concern, reports of kernicterus appear to be increasing.

What can we do?

Shorter hospital stays for newborns are unlikely to change. As health care team members who spend the most time with newborns, nurses should be aware of causes, and risk factors for hyperbilirubinemia. With such knowledge applied during the hospital stay, neonates are more likely to:

• Be identified
• Receive treatment
• Receive appropriate follow-up for neonatal jaundice