Bilirubin is the yellow pigment that is left over when red blood cells break down. The liver normally absorbs and processes bilirubin, but in the newborn there are not enough enzymes present yet for the liver to absorb and metabolize the bilirubin. Therefore, about the second to fourth day after birth, the skin and eyes become yellow-tinted. If the jaundice is not treated, high levels of bilirubin can lead to brain damage.
In the newborn, the liver is not mature enough to have adequate levels of enzymes present to metabolize the bilirubin fast enough. Premature infants are at higher risk of jaundice as well as those who have had bruising during birth (as with forcep or vacuum assisted delivery), when there is a blood type difference between mother and baby, and in cases of neonatal sepsis. Breastfeeding infants will often develop jaundice as a result of dehydration or not enough calorie intake if they are having difficulty nursing.
Patient will have decreased yellowing of the skin and eyes; patient will have adequate nutritional intake; patient will have bilirubin level within normal range.
Patient’s mother/caregiver reports:
Assess infant for skin abnormalities; note color (yellowing) of skin or eyes
Yellowing of the skin can be determined by lightly pressing on the skin of a baby’s forehead. This is the most common indicator of neonatal jaundice.
Assess infant for neurological involvement
Obtain history of pregnancy and delivery
Obtain serum or transcutaneous bilirubin level
Observe breastfeeding and offer assistance to improve latch and encourage frequent feedings every 2 hours; supplement with formula as appropriate
Begin phototherapy per facility protocol
Baby will be placed under bili lights or blanket. Phototherapy helps improve the solubility of bilirubin for faster excretion through the stool and urine. This is non-invasive treatment.
Monitor infants skin and eyes every 2 hours during phototherapy
Monitor for increased temperature / fever
Patient may experience higher temperature with bili lights; note signs of fever that may indicate infection or sepsis
Administer medication or blood transfusion as appropriate
Provide education for patient’s parents/caregivers regarding care for infant with jaundice
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