Pathophysiology of Hyperbilirubinemia

A newborn’s liver may not be mature enough in the first week of life to prevent jaundice,

which results from hyperbilirubinemia. A major function of the liver is the conjugation of

bilirubin, therefore immature livers create excessive bilirubin in the blood. Bilirubin is made by

the breakdown of red blood cells. It’s hard for babies to get rid of bilirubin at first. It can build up

in their blood, tissues, and fluids. During pregnancy, the placenta removes bilirubin from the

baby’s blood. When a baby is born, the baby's liver takes over this job. The baby may have too

much bilirubin for many reasons. Elevated levels of bilirubin can travel to the baby’s brain,

which can cause seizures and brain damage.

There are diverse types of jaundice to diagnose, some which include: Jaundice caused by

poor liver function: jaundice can happen if the baby’s liver doesn’t work well. The liver is the

part of the body most responsible for getting rid of bilirubin. A problem with the liver can cause

higher levels of bilirubin. physiologic jaundice; during the first few days of life this normal type

of jaundice happens as a response to a baby’s reduced ability to remove bilirubin from the body.

Breastfeeding failure jaundice: some babies don’t breastfeed well at first. Not feeding well

makes the baby dehydrated. It also causes the baby to urinate and defecate less. This makes

bilirubin build up in the baby’s body. Babies born between 34 to 36 weeks of pregnancy are

more likely to get this problem, but this condition is also common in early term newborns. It can

also happen in any newborns who have had a difficult start, especially if they were separated

from their mother and unable to feed frequently. It usually gets better once a baby learns how to

breastfeed well. Breastmilk jaundice: this issue may be caused by a substance in breastmilk

which may increase how much bilirubin the baby's body can reabsorb. This happens later

in their first week of life. It peaks at about 2 weeks of age and can last 3 to 12 weeks. Jaundice
from hemolysis: if the baby has Rh disease, he or she may get this type of jaundice. This issue

can also be from having too many red blood cells or rare problems in which the red blood cells

are more fragile than normal.

Signs and symptoms of hyperbilirubinemia can occur a bit differently in each child from mild to

severe. They generally include: yellowing of the baby’s skin and the whites of his or her eyes.

This often starts on a baby’s face and moves down his or her body. Poor feeding and lack of

energy. Risk factors are: excess production, red blood cell life, blood incompatibility, gestation,

liver immaturity, albumin binding sites, intestinal factors, trauma, feeding, family background,

fatty acids, or other factors such as a maternal health complication.

Treatment will depend on the child’s symptoms, age, and general health. It will also

depend on how severe the condition is. Phototherapy: high bilirubin levels often decrease when a

baby is put under special blue spectrum lights. It may take several hours for it to start working.

During light treatment, the baby’s eye will be protected. The baby’s healthcare provider will

check the baby’s temperature and test bilirubin levels which will tell if phototherapy is working.

Fiber optic blanket: a fiber optic blanket is another form of phototherapy. The blanket is usually

put under the baby. It may be used alone or with regular phototherapy. Exchange transfusion:

This treatment removes the baby’s blood that has a high bilirubin level and replaces it with fresh

blood. This raises the baby’s red blood cell count. During the procedure, the baby will switch

between giving and getting tiny amounts of blood. This will be done through a vein or artery in

the baby's umbilical cord. It is only done in an intensive care nursery when bilirubin levels are

extremely high. The baby may need to have this procedure again if his or her bilirubin levels stay

high. Feeding with breastmilk: it is highly encouraged to continue to breastfeed a baby with
jaundice. If the baby has not been getting enough milk at the breast, you may need to supplement

with pumped breastmilk or formula. The more feeding that takes place the faster the baby can get

rid of the excess bilirubin through output. Nurses must provide education to the parents, be

supportive, kind, compassion and caring through the process.

(Maternal-child Nursing, 5th edition.)

(https://nurseslabs.com/hyperbilirubinemia nursing care plans)

Neonatal Hyperbilirubinemia in Preterm Neonates, An Issue of Clinics in Perinatology, 1e (The

Clinics: Internal Medicine)