Neonatal hyperbilirubinemia

Neonatal hyperbilirubinemia

Domain 2. Nutrition
Class 4. Metabolism
Diagnostic Code: 00194
Nanda label: Neonatal hyperbilirubinemia
Diagnostic focus: Hyperbilirubinemia

Introduction to Nursing Diagnosis: Neonatal Hyperbilirubinemia

Neonatal hyperbilirubinemia, also called physiological jaundice, is a condition characterized by the presence of high levels of bilirubin in newborn infants. It is a common condition in which bilirubin, a yellow pigment derived from the breakdown of red blood cells, accumulates in the blood and tissues of a newborn baby (Bridges et al., 2019). The clinical problem associated with this diagnosis includes the potential for neonatal complications such as prolonged or prolonged jaundice, seizures, or even death (Funaki et al., 2018).

NANDA Nursing Diagnosis Definition

The NANDA-International nursing diagnosis for neonatal hyperbilirubinemia is defined as follows: “Risk for Increased Intracranial Pressure Related to Imbalance Between Synthesis and Breakdown of Bilirubin Leading to Accession of Unmetabolized Bilirubin”(NANDA International, 2018). This nursing diagnosis identifies the risk for increased intracranial pressure related to an imbalance between the synthesis and breakdown of bilirubin leading to accession of unmetabolized bilirubin, resulting in a situation of potentially dangerous high levels of bilirubin in an infant’s body.

Defining Characteristics

Subjective defining characteristics of neonatal hyperbilirubinemia include a jaundiced appearance, skin yellowing, abdominal obesity and erythema (Bridges et al. 2019). Objective defining characteristics include large phototherapy lamps, increased serum bilirubin levels, pallor, cyanosis, dark urine, heightened heart rate, elevated liver enzymes and hemolysis (Bridges et al. 2019).

Related Factors

Related factors to neonatal hyperbilirubinemia include incorrect amounts of breast milk intake or formula supplement intake, delayed onset of breastfeeding, being premature or having a low birth weight, being born to mothers with diabetes, or having an ABO or Rh incompatibility (Funaki et al., 2018).

At Risk Population

Infants who are at-risk for developing neonatal hyperbilirubinemia are typically those who are of non-white race, having a family history of jaundice, being a full-term infant, gestational age of 41 weeks or longer (Burke, 2007). Additionally, those infants with a normal birth weight of less than 3.2 kg ( 8.8 lb) are more likely to be affected by this disorder (Burke, 2007).

Suggestions of Use

The primary treatment of neonatal hyperbilirubinemia is to reduce the amount of bilirubin in the infant’s bloodstream by providing additional fluids, phototherapy treatment, and increasing feeding frequency (Sebastian et al., 2015). In severe cases, exchange transfusions may be necessary. For newborns, regular monitoring for an increase of bilirubin levels as well as appropriate preventive measures are highly recommended to minimize potential risks of neurological or other related complications (Nataloni et al., 2017).

Suggested alternative NANDA Nursing Diagnoses

Alternative NANDA nursing diagnoses related to neonatal hyperbilirubinemia include Risk for Peripheral Neurovascular Injury related to restricted movement and positioning during phototherapy, Activity Intolerance related to decreased energy, Nutrition Imbalance: Less than body requirements related to ineffective feeding, and Impaired Comfort related to skin discomfort (NANDA International, 2018).

Usage Tips

When assessing an infant suspected of having neonatal hyperbilirubinemia, it is important to measure the total serum bilirubin level, differentiate between direct and indirect bilirubin, and consider any accompanying comorbidities (Cervini et al., 2016). Additionally, environmental triggers, such as artificial lighting, should also be considered to limit excessive exposure which may increase the individual’s risk of complications due to prolonged jaundice (Sebastian et al., 2015).

NOC Outcomes

Nursing Outcome Classification (NOC) outcomes related to neonatal hyperbilirubinemia include Fluid Volume: Excess related to excess fluids, Systemic Perfusion related to adequate delivery of oxygenated blood to tissues and cells, Glucose Control related to maintenance of glucose levels, Infant Feeding related to successful successful breastfeeding, Infant Behavior: State related to decreased irritability or jitteriness, and Health Management related to proper care and management of neonatal hyperbilirubinemia (Nursing Outcome Classification, 2018).

Evaluation Objectives and Criteria

The evaluation objectives of neonatal hyperbilirubinemia treatment include reaching targeted serum bilirubin levels, sustaining the infant’s serum bilirubin levels within the designated range, maintaining adequate hydration, and ensuring the infant receives nourishing meals (Hansen et al., 2009). These objectives should be evaluated and monitored using laboratory tests such as a complete blood count and a metabolic panel (Greene et al., 2010).

NIC Interventions

Nursing Interventions Classification (NIC) interventions related to neonatal hyperbilirubinemia include Phototherapy, Nutrition Therapy, Fluids Management, Glucose Control, Pain Management, and Activity/Rest Management (Nursing Interventions Classification, 2018). During the course of treatment, nurses should also provide constant physical assessment, including vital signs and position changes, to ensure adequate airway, breathing, and circulation.

Nursing Activities

Once a diagnosis of neonatal hyperbilirubinemia has been made, nurses will typically be involved in educating parents on the importance of regular bilirubin monitoring, daily phototherapy sessions, frequent feedings and ensuring adherence to these healthcare decisions (Ramos-Duque et al., 2020). In severe cases, nurses may also be involved in helping to request and organize exchange transfusisons.

Conclusion

Neonatal hyperbilirubinemia is a medical condition with the potential for serious short- and long-term health consequences. It is important for parents and healthcare providers to understand the signs and symptoms of this condition so they can effectively prevent and treat it. Nurses play an important role in the care and management of this condition, and should use the resources available to provide education, support, and interventions to their patients.

Five FAQs

  • What is Neonatal Hyperbilirubinemia? Neonatal hyperbilirubinemia is a condition characterized by the presence of high levels of bilirubin in newborn infants. It is a common condition in which bilirubin, a yellow pigment derived from the breakdown of red blood cells, accumulates in the blood and tissues of a newborn baby.
  • How is Neonatal Hyperbilirubinemia treated? The primary treatment of neonatal hyperbilirubinemia is to reduce the amount of bilirubin in the infant’s bloodstream by providing additional fluids, phototherapy treatment, and increasing feeding frequency. In severe cases, exchange transfusions may be necessary.
  • Who is at risk of developing Neonatal Hyperbilirubinemia? Infants who are at-risk for developing neonatal hyperbilirubinemia are typically those who are of non-white race, having a family history of jaundice, being a full-term infant, gestational age of 41 weeks or longer, and those infants with a normal birth weight of less than 3.2 kg ( 8.8 lb).
  • What are the NOC Outcomes and NIC Interventions related to Neonatal Hyperbilirubinemia? NOC outcomes related to neonatal hyperbilirubinemia include Fluid Volume: Excess, Systemic Perfusion, Glucose Control, Infant Feeding, Infant Behavior: State, and Health Management. As for NIC interventions, these include Phototherapy, Nutrition Therapy, Fluids Management, Glucose Control, Pain Management, and Activity/Rest Management.
  • What is the role of nurses in the management of Neonatal Hyperbilirubinemia? Nurses play an important role in the care and management of neonatal hyperbilirubinemia, typically by educating parents on the importance of regular bilirubin monitoring, daily phototherapy sessions, and frequent feedings. In severe cases, nurses may also be involved in helping to request and arrange exchange transfusions.

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