Hyperbilirubinemia

3. 1. Due to low oxygen tension in fetal blood , the fetus
has a high hemoglobin and hematocrit.
2. At birth , oxygen tension increases and the extra
RBCs are no longer needed .
3. The infant begins breaking down the excessive
RBCs.
4. As RBCs are broken down , indirect bilirubin is
released .

4. 5. Indirect bilirubin (unconjugated) is fat
soluble.
6. The liver converts indirect bilirubin to
direct bilirubin (conjugated), which is
water soluble and can be excreted in the
urine.
7. In the normal newborn , the direct
bilirubin reaches its peak at about three
days of life and then starts to decrease.
This is termed physiologic jaundice .

5. 8. In a child with hyperbilirubinemia , the indirect
bilirubin level may start climbing within hours of
birth or the level of indirect bilirubin is excessive
interfering with brain function.
9. Normal indirect (unconjugated) bilirubin levels are
below 1.4mg/dl.

6.  Following birth , the liver is unable to convert indirect bilirubin
to direct bilirubin adequately.
 The direct bilirubin builds up
In the blood and collects in fat-rich
tissue including the skin and the
lining of the brain.
 When the indirect bilirubin level
reaches toxic range, the brain
will be affected .
 This bilirubin encephalopathy is called kernicterus.
 Any condition that stresses the liver will delay the conjugation
and increase the risk of hyperbilirubinemia.

7.  Causes of hyperbilirubinemia , include RH and
ABO incompatibility , prematurity and immaturity
, any injury which increases blood cell
destruction such as bruising , petechiae , and
hematomas, infant of a diabetic mother , cold
stress , infection , and breast-feeding.

8.  Yellow appearance to the skin : The skin
discoloration begins on the face and spreads
caudally . Sclera also appear yellow .
 As kernicterus develops , additional symptoms
may be seen . Such as :
1. Poor feeding.
2. High pitched shrill cry .
3. Lethargy or irritability .

10.  Based on bilirubin levels
 Liver function test .
 blood tests
 ultrasound scan.
 CT
 MRI

11.  Phototherapy . Exchange transfusions are done only
in the most extreme cases.
 Intravenous immunoglobulin

12.  Sepsis in bile ducts.
 Biliary cirrhosis.
 Pancreatitis
 Coagulopathy
 Hepatic and renal failure.

13. 1. Provide phototherapy , which slowly converts the
indirect bilirubin on the skin surface so that it can be
excreted . It is important that the treatment be
continuous.
2. Ensure that the child is uncovered except genitalia
and eyes
3. Cover the eyes with occlusive pads
4. Turn the infant frequently

14. 5. . A Use no lotions or oils on the infant’s skin to
prevent burning
6. Provide extra water feeding
7. Maintain body temperature within normal limits
8. Provide diaper care frequently as the stool tend to
be loose and irritating