SCHOOL OF HEALTH AND ALLIED HEALTH SCIENCES

Nursing Department

SELF-DIRECTED LEARNING (NUR 146 - CLINICAL AREA)

Name: CABAHUG, VICTORIA MAE I DATE: MAY 26, 2021

I. Define the following terms:

1. Apnea - is the cessation of breathing. During apnea, there is no movement of the muscles
of inhalation, and the volume of the lungs initially remains unchanged.

2. Respiratory distress syndrome (RDS) is a common breathing disorder that affects

premature newborns because their lungs are not able to make enough surfactant. The lack
of oxygen can damage the baby's brain and other organs if not treated promptly.

3. Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a
seemingly healthy baby less than a year old. SIDS is sometimes known as crib death
because the infants often die in their cribs.

4. Meconium aspiration syndrome is trouble breathing (respiratory distress) in a newborn

who has breathed (aspirated) a dark green, sterile fecal material called meconium into the
lungs before or around the time of birth.

5. Hyperbilirubinemia is a condition in which there is a buildup of bilirubin in the blood,

causing yellow discoloration of the eyes and skin, called jaundice.

6. Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal

accumulation of fluid in two or more fetal compartments, including ascites, pleural
effusion, pericardial effusion, and skin edema. In some patients, it may also be associated
with polyhydramnios and placental edema.

7. Kernicterus is a very rare type of brain damage that occurs in a newborn with severe
jaundice. It happens when a substance in the blood, called bilirubin, builds up to very
high levels and spreads into the brain tissues. This causes permanent brain damage.

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 8. Physiologic Jaundice - Yellowish staining of the skin and whites of the newborn's eyes
(sclerae) by pigment of bile (bilirubin).

9. Pathologic Jaundice - Jaundice is considered pathologic if it presents within the first 24

hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol
per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and
symptoms suggestive of serious illness.

10. Conventional Phototherapy - During phototherapy, the neonate skin is exposed to a light
source of specific wavelength which aids in decreasing bilirubin levels. Conventional
phototherapy uses compact fluorescent (CFL) or halogen lamps.

11. Fibreoptic phototherapy is a new type of phototherapy in which the light is applied
directly to the skin of the infant via optical fibers, enabling the infants to be nursed fully
clothed near to their parents.

II. Case Study

You receive a call indicating a jaundiced baby boy and they would like you to have a
look at.
You meet with the parents to review the history. You learn that mom is a 33yo,
G2T1A0L1 healthy woman. She was HepB/HIV negative and rubella immune. Her blood group
is O positive. There were no significant infections during the pregnancy. She received regular
pre-natal care at the maternity center.
Family has a 10-yr-old boy who did not have trouble with jaundice as an infant. There is
no known history of liver disease or inborn errors of metabolism.
Mom was booked for C-section for transverse lie but went into spontaneous labor at 37
weeks’ gestation. Baby was noted to be vertex at that point. The labor was augmented with
oxytocin and baby Jayden delivered vaginally. There were no HR decelerations or maternal
temperature noted. Membranes ruptured spontaneously 2 hours prior to delivery. Baby was
vigorous with Apgars 9 (1) and 9 (5). Birth weight was 3306 g, length 49 cm and head
circumference 35 cm. Baby was placed skin-to-skin immediately after delivery and initiated
breast feeding.
Jayden was in breast feeding in the hospital and was discharged home at 36 hours of age.
Bilirubin at discharge was in high and follow up check was arranged. At home, breast feeding is
continued frequently. He is now 59 hours old and is having 3 stools and 4-5 wet diapers per day.
Jayden's sclera and skin appear jaundiced. He has moist membranes, normotensive
fontanelle and normal skin turgour. No signs of infection and with no underlying disorders. He
awakens for examination and appears alert with normal tone. There is no hepatosplenomegaly.
Phototherapy is advised to Jayden.

Questions:

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1. What are the most common causes of pathologic hyperbilirubinemia in neonates?
Causes of increased bilirubin production in pathologic jaundice are immune-mediated
hemolysis such as ABO and Rhesus incompatibility, non-immune mediated causes such as
cephalhematoma, red blood cell membrane defects like hereditary spherocytosis and
elliptocytosis, enzyme defects like glucose-6-phosphate dehydrogenase (G6PD) deficiency
and pyruvate kinase.

2. What are the 2 most common types of neonatal hyperbilirubinemia?

 Pathologic jaundice. Pathologic jaundice is the most serious type of jaundice. It

occurs within 24 hours after birth, and is characterized by a rapid rise in a baby’s
bilirubin level. The most likely cause is blood incompatibility or liver disease. Prompt
medical attention is necessary, and blood transfusions may be required.
Breastfeeding can continue during treatment.

 Physiologic (neonatal) jaundice. Physiologic jaundice usually appears at day 2-5 and

lasts about 10–12 days. The best treatment for physiologic jaundice is frequent and
effective breastfeeding—at least 8-12 or more times in each 24-hour period. Giving
water, glucose water, or formula supplements won't help because they lack the
laxative effect of colostrum. Instead, they can interrupt development of the mother's
milk supply and increase the risk of weaning.

2. In Jayden’s case, you suspect that the type of hyperbilirubinemia is?

Physiologic Jaundice

3. What are the possible laboratory/diagnostic tests to be done to Jayden?

In most cases, a bilirubinometer is used to check for jaundice in babies. Blood tests are

usually only necessary if your baby developed jaundice within 24 hours of birth or the
reading is particularly high. The level of bilirubin detected in your baby's blood is used to
decide whether any treatment is needed.

4. What are the common treatment/management plans for Jayden?

Treatments to lower the level of bilirubin in your baby's blood may include: Enhanced
nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or
supplementation to ensure that your baby receives adequate nutrition. Light therapy
(phototherapy).

5. What level of bilirubin requires phototherapy?

Phototherapy should be instituted when the total serum bilirubin level is at or above
15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in
infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours.

6. How does phototherapy work to Jayden’s jaundice?

Phototherapy is treatment with a special type of light (not sunlight). It can lower the
bilirubin levels in your Jayden’s blood through a process called photo-oxidation.
Photooxidation adds oxygen to the bilirubin so it dissolves easily in water.

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7. Supply the rationale to the following considerations during Jayden’s conventional
phototherapy:

a. eyes should be covered- Eye covers for newborns are standard

prophylaxis. Your baby needs to wear soft eye goggles to protect his or her eyes
from the bright lights.

b. monitor body temperature- closer monitoring of body temperature is needed

for newborns under phototherapy at high irradiances

c. assess skin turgor and monitor intake and output- skin turgor is often used
as a way to check for dehydration. The irradiance of the light is at least 30µW/cm2
per nm as measured at the baby's skin below the center of the phototherapy lamp.
A hand-held radiometer can be used to measure the spectral irradiance emitted by
the light.

d. continue breastfeeding- Phototherapy is the most common treatment for

jaundice, and involves the baby either being placed directly under a special blue
light, or on a bed or in a blanket that contains this special blue light.

e. should be undressed- The lights shine on the baby's skin and change the
bilirubin. It can then pass out of the body through the urine and stool. Your baby will
need to be under the light for about 1 to 2 days. He may also lie on a blanket of
light, called a biliblanket.

f. should wear diaper- Your baby must wear a diaper while receiving
phototherapy. Phototherapy may cause loose, watery stools, as the bilirubin leaves
the body. As bilirubin levels decrease, your baby may get a pain-less, bluish-red skin
rash (bilirash). It will go away after the therapy is complete.

SOURCES:

https://www.ncbi.nlm.nih.gov/books/NBK532930/
https://babygooroo.com/articles/causes-types-of-jaundice-explained
https://www.nhs.uk/conditions/jaundice-newborn/diagnosis/