Risk Of Neonatal Hyperbilirubinemia (Jaundice)

Introduction to Risk of Neonatal Hyperbilirubinemia

Risk of neonatal hyperbilirubinemia (jaundice) is a common diagnosis and involves an increased level of bilirubin in the blood of newborn infants. Research has demonstrated that elevated bilirubin levels can lead to severe neurological effects, such as deafness and cerebral palsy, and even intellectual disability.

Nursing Diagnosis Definition

Risk of Neonatal Hyperbilirubinemia (Jaundice): At risk for abnormally high levels of bilirubin in the blood of an infant.

Defining Characteristics

Subjective Data

• Data from family or significant other regarding infant's yellow skin color.
• Concern from caregiver about color or lethargy of infant.
• Suspicion of infant being jaundiced by medical staff.

Objective Data

• Bluish discoloration of infants' hands and feet.
• Presence of yellow coloration of skin and/or eyes.
• Slow weight gain or poor feeding.

Related Factors

• Excess production of bilirubin secondary to inherent genetic abnormalities.
• Delayed or impaired transport of bilirubin due to liver dysfunction or hypoxia.
• Prematurity.
• Cephalohematoma.
• Mother with a history of Rh sensitization.
• Bruising.
• Blood type incompatibility between mothers and infant.
• Ineffective tissue perfusion.
• Inability to metabolize Bilirubin.
• Obstruction of bile duct.
• Septicemia.
• Respiratory distress syndrome.

Risk Population

The risk population for Neonatal Hyperbilirubinemia includes: Premature infants, full-term infants, and infants arising from a pregnancy complicated by Rh sensitization or by any condition or disease producing an altered metabolic state.

Associated Problems

• Brain Damage.
• Kernicterus.
• Hearing Defects.
• Hydrocephalus.
• Growth deficiencies.

Suggestions of Use

When assessing a newborn infant for Neonatal Hyperbilirubinemia, nursing interventions to use include obtaining an accurate history of maternal and fetal factors, performing physical assessments, monitoring bilirubin levels, initiating phototherapy if indicated, and providing anticipatory guidance to parents.

Suggested Alternative Nursing Diagnosis

• Risk for Infant Infection.
• Risk for Fluid Volume Excess.
• Risk for Ineffective Tissue Perfusion.
• Risk for Unstable Blood Glucose Level.
• Acute Pain.

Usage Tips

• Risk of Neonatal Hyperbilirubinemia should be used as a diagnosis when the infant has not yet manifested signs and symptoms of the disorder.
• This diagnosis is appropriate for use when the infant is at risk for developing Neonatal Hyperbilirubinemia due to factors such as prematurity and Rh sensitization, but serum bilirubin levels have not yet reached dangerous levels.
• It is important to monitor and assess for signs and symptoms of Neonatal Hyperbilirubinemia, as early identification of an elevated bilirubin level can prevent permanent brain damage or death.

NOC Results

Expected Outcomes

• Infant will maintain normal serum bilirubin level.
• Parents will verbalize understanding of risk factors and prevention strategies for Neonatal Hyperbilirubinemia.
• Parents will demonstrate techniques for evaluating infant's skin color.

NIC Interventions

Independent

• Monitor serum bilirubin levels in high-risk neonates.
• Administer phototherapy as indicated.
• Instruct mother/caregiver on techniques to evaluate skin color.
• Provide health education to mother/caregiver regarding prevention of hyperbilirubinemia.

Collaborative

• Refer the infant to hematology for further evaluation and treatment for neonatal hyperbilirubinemia.
• Monitor for signs of infection.
• Assess for evidence of hydrocephalus.
• Plan for discharge teaching regarding infant follow up.

Conclusion

Risk of Neonatal Hyperbilirubinemia is an important nursing diagnosis to consider in assessing newborn infants. Early identification of a risk for this condition is essential to preventing potentially devastating outcomes in an infant. Proper assessment, monitoring, and nursing interventions are necessary to provide the best care for the neonate.

FAQ

• What is Neonatal Hyperbilirubinemia? Neonatal Hyperbilirubinemia, also known as jaundice, is a condition where there is an excess of the pigment bilirubin in the blood of a newborn.
• What are risk factors for Neonatal Hyperbilirubinemia? Risk factors for this condition include prematurity, cephalohematoma, blood type incompatibility, and Rh sensitization in the mother.
• How is Neonatal Hyperbilirubinemia diagnosed? Neonatal Hyperbilirubinemia can be diagnosed through physical assessment of the infant, including evaluation of the infant's skin and eye color. The level of bilirubin in the infant's blood can also be tested.
• How is Neonatal Hyperbilirubinemia treated? Treatment depends on the severity of the condition, but typically includes administration of phototherapy, as well as providing anticipatory guidance and patient education.