Patient Teaching Jaundice - Weebly

Patient Teaching Jaundice

The most common abnormal physical finding in newborns is jaundice (icterus neonatorum). Jaundice is a yellowish coloration of the skin and sclera of the eyes that develops from the deposit of yellow pigment bilirubin in lipid/fat-containing tissue. (Davidson, London, and Ladewig ) Conjugation (the changing of bilirubin into the excretable form) is the conversion of yellow low lipid-soluble pigment, which is unconjugated, into water soluble pigment, which is excretable. While in-utero the fetal unconjugated bilirubin crosses the placenta to be excreted. (Davidson, London, and Ladewig ) Therefore the fetus does not need to conjugate bilirubin while in-utero.

After birth, the newborn's liver must begin to conjugate bilirubin. This produces a rise in the serum bilirubin in the first few days of life. The unconjugated bilirubin formed is transported in the blood bound to albumin. The bilirubin is transferred into the hepatocytes and bound to intracellular proteins. These proteins determine the amount of bilirubin that is held in the liver cells for processing and determine the amount of bilirubin uptake into the liver. (Davidson, London, and Ladewig ) From here the conjugated bilirubin is prepared to be excreted.

Physiologic jaundice is caused by accelerated destruction of fetal RBC's, impaired conjugation of bilirubin, and increased bilirubin reabsorption from the intestinal tract. This is a normal biologic response of a newborn. The signs of physiologic jaundice appear after the first 24 hours postnatally. The jaundice is usually not visible after 14 days. This form of jaundice may require phototherapy treatment.

Pathologic jaundice is primarily caused by hemolytic disease of the newborn. Serum albumin-binding sites are usually able to conjugate enough bilirubin to meet the demands of the normal newborn. (Davidson, London, and Ladewig ) Certain conditions can decrease the number or the quality of the available binding sites. Conditions that can cause this include fetal or neonatal asphyxia, neonatal drugs, hypothermia, hypoglycemia, maternal use of sulfa or salicylates, and premature birth of the infant. Bilirubin not bound to albumin is free to cross the blood-brain barrier, damage cells of the CNS, and produce kernicterus or acute bilirubin encephalopathy. Pathological jaundice is suspected if jaundice appears within the first 24 hours of life. The best treatment is prevention. However management of this disease is directed towards alleviating as much albumin "tieing up" factors as possible. Phototherapy, exchange transfusion, and drug therapy are also used to treat pathologic jaundice.

Discharge teaching for the parents of a jaundice infant is crucial. Some things to note are: The infants skin and sclera (whites of their eyes) will look yellow. To help break down the bilirubin, the infant will be placed under bright lights (phototherapy) in a warm enclosed bed. They will wear only a diaper and special eye shades. The infant may have an intravenous (IV) line to give them fluids during treatment. The infant may need treatment called a double volume blood exchange transfusion. This is used when the baby's bilirubin level is very high. Unless there are other problems, the infant will be able to feed (by breast or bottle) normally. The doctor may stop phototherapy and send the infant home when their bilirubin level is low enough to be safe. The doctor will need to check the infants bilirubin level in the doctor's office, 24 hours after therapy stops, to make sure the level is not rising again. Possible side effects of phototherapy are watery diarrhea, dehydration, and skin rash that will go away once the therapy stops. What to Expect at Home

If your child did not have jaundice at birth but now has it, you should take them to the doctor when they are 3 days old. Bilirubin levels are generally the highest when a newborn is 3 to 5 days old. If the bilirubin level is not too high or not rising quickly, you can do phototherapy at home with a fiberoptic blanket, which has tiny bright lights in it. You may also use a bed that shines light up from the mattress. A nurse can come to your home to teach you how to use the blanket or bed and to check on your child. The nurse will return daily to check your child's: ?Weight ?Intake of breast milk or formula ?Number of wet and poopy (stool) diapers ?Skin, to see how far down (head to toe) the yellow color goes ?Bilirubin level When to Call the Doctor Call your baby's doctor if your baby is: ?Lethargic (hard to wake up), less responsive, or fussy ?Refusing the bottle or breast more than 2 feedings in a row ?Having problems breastfeeding, losing weight, or has watery diarrhea ?Turning yellow - eyes, belly, arms, or legs ?Turning more yellow (jaundice is getting worse)

?Has yellow color that goes away, but then comes back after treatment stops ?Has yellow color that lasts for more than 2 to 3 weeks ?If you have any concerns

References Davidson, M. R., M. L. London, and P. W. Ladewig. Olds\' maternal-newborn nursing

& women\'s health, across the lifespan. 9. Boston: Prentice Hall, 2012. Print.

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