Objective

General

This case study aims to present to the readers the nature of hyperbilirubinemia
Secondary to prematurity related to presume sepsis, the origin and the effects it
does on the neonate body. It also encompasses the proper approach in a patient
with this kind of disease. This study aims to broaden the knowledge of the
readers about this condition.

Specific Objectives

To improve Knowledge on:

• The fundamental info about Hyperbilirubinemia including its risk factors,
etiology, signs and symptoms, and treatment.
• The correlation of Hypebilirubinemia, presumed sepsis Neonatorum and
prematurity.

To enhance Skills on:

• The appropriate approach to a newborn patient undergoing systemic
changes and adaptation.
• Formulating nursing care plans and independent nursing interventions to
care for fully dependent patient.

To modify attitude on:

• caring a newborn patient with hyperbilirubinemia
• Confidence in managing patients with this kind of condition.

Introduction

Background of the study

This is a case of baby girl E, 1 day old, born and admitted at Valenzuela General
Hospital, was diagnosed of having hyperbilirubinemia secondary to prematurity
ruled out sepsis.

We decided to present this case due to their eagerness to learn and explore new
knowledge and information about this type of newborn condition. The group
wants to formulate a correlation among the three conditions that manifests in
baby girl E they believes that this can be of great help in performing appropriate
interventions to the patient. This group also wants to focus on hyperbilirubinemia,
which is a common among newborns. It is a significant topic for the mothers
especially those who are in their reproductive age. Being within this range, it is of
great advantage that they have knowledge of this condition

Definition
 Hyperbilirubinemia is a condition in which there is too much bilirubin in the blood.
When red blood cells break down, a substance called bilirubin is formed. Babies
are not easily able to get rid of the bilirubin and it can build up in the blood and
other tissues and fluids of the baby's body. This is called hyperbilirubinemia.
Because bilirubin has a pigment or coloring, it causes a yellowing of the baby's
skin and tissues. This is called jaundice.

Depending on the cause of the hyperbilirubinemia, jaundice may appear at birth

or at any time afterward.

General signs and symptoms

• Yellow eyes • Fatigue

• Yellow skin • Light coloured stools
• Tiredness • Dark urine

Etiology

During the pregnancy, the placenta excretes bilirubin. When the baby is born, the
liver of the baby must take over this function. There are several causes of
hyperbili and jaundice, including the following:

• Physioclogic jaundice
This is a normal response to the baby’s limited ability to excrete bilirubin in the
first days of life. The manifestation of jaundice is after 24 hours.

• Breast milk jaundice

About 2% of the breastfed babies develop jaundice after the first week. Some
develop breast milk jaundice in the first week due to low calorie intake or
dehydration.

• Jaundice from hemolysis

Jaundice may occur with the breakdown of RBC’s due to haemolytic disease of
the newborn (RH disease), having too many RBCs or bleeding

• Pathologic jaundice
This may be related to inadequate liver function due to infection or other factors.
The manifestation of jaundice is within 24 hours

Incidence

• Global

Source: Canadian pediatric surveillance program

Severe hyperbilirubinemia is the most common cause of neonatal readmission to
hospital even though, in the majority of cases, risk factors can be identified before
discharge. Severe neonatal hyperbilirubinemia and kernicterus continue to be
reported worldwide in otherwise healthy term infants. We conducted this study to
estimate the incidence of severe neonatal hyperbilirubinemia and to determine
underlying causes, improved knowledge of which would be valuable to help
identify strategies for risk reduction.

Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in

the first 3 days after birth.

• Local

Source: Department of Health

In the phil. There is a prevalence rate of 4.5% to 25.7%

In the present study, 3278 male newborns were screend for hyper bili
Results show that of 3278 boys, 186 screened to have a positive result. Of the
186, 65 boys had a confirmatory testing, 45 were confirmed to have hyper bili
and 20 had normal results. This study reveals an incidence of 3.9% among male
Filipinos.

Patient Profile

• Name: Baby Girl E

• Age: 1 day old

• Gender: female

• Birth day: July 1, 2010

• Place of birth: Pazo del Blaz

• Nationality: Filipino

• Parents:

Mother
Name: T Espinoza
Occupation: housewife
G2P2

Father
Name: J Espinoza
 Occupation: Welder

Chief complaint: prematurity

Physical exam

Appearance:
• jaundice, good skin turgor

Head:
• normocephalic and symmetrical
• Non bulging and non depressed anterior and posterior fontanels
• No signs of caput succedaneum and cephalohematoma

Face
• round and symmetrical

Ears
• normal ears symmetry pinna springs back slowly

Eyes
• icteric sclera with clear cornea
• Pupils equally round, reactive to light and accommodation

Nose
• nares are bilateral
• No signs of nasal flaring

Mouth
• Dry oral mucous membrane
• Frenelum intact at midline

Chest
• Symmetrical, chest expansion with clear breath sounds
• Negative retractions

Abdomen
• Globular soft without distention
• Bowel sounds in all quadrant
• Skin pinch goes back slowly

Genitalia
• Clearly differentiated

Elimination
 • Patent anus
• Stool: yellow, consistent

Muscle tone
• Weak muscle tone
• Symmetrical extremities

Present history
• The patient is a live preterm newborn female delivered via NSD
• Non hypertensive, non diabetic, non asthmatic mother

Allergy
• No known allergy

Course on ward

July 5, 2010 to July 7, 2010

Patient admitted at neonatal intensive care unit (NICU ward), under photo
therapy; IV level at 54cc with D5 IMB. Patient was given a warm bath as advised
by the doctor.
The patient was still positive for jaundice so photo therapy was given at every 4
hours interval. Intake and output were monitored, vital signs were constantly
checked, and IV was removed at July 7, 2010.
The mother of the patient breast fed the baby continuously.

Laboratory exam

Normal
Value Value Indication
0.3-1.3 an abnormal accumulation of bilirubin in the blood caused
Bilirubin 18.9mg/dl mg/dl by the poor function of the liver
30.81 5.0-10.0
WBC 10^9/L 10^9/L increase in value indicates an infection

Basically, this means there is an accumulation of bilirubin with in the blood

stream that’s trying to get out. And since this is considered a foreign substance
that can’t be excreted normally by our body, it is being fought by the WBC’s of
our body.
Pathophysiology
 Drug study
CLASSIFICATION
NAME OF ADVERSE CONTRAINDICATIO NURSING
& INDICATIONS
DRUGS REACTION N RESPONSIBILITY
ACTION

oxacillin penicillins. Used Susceptible Fever; rash; Hypersensitivity to Obtain

(Bactocill) in the treatment infections diarrhoea, nausea, penicillins. specimen for
Injection, of systemic due to vomiting; Renal impairment; culture and
Solution infections. penicillinase- agranulocytosis, asthmatic patients; sensitivity
in Plastic producing eosinophilia, porphyria. Elderly; tests before
Container staphylococci leukopenia, neonates. giving first
Child: <40 . neutropenia, Prolonged use may dose.
kg: 50-100 thrombocytopenia; result in fungal or Therapy may
mg/kg/day in AST increased, bacterial begin while
divided hepatotoxicity; superinfection, awaiting
doses. Doses acute interstitial including C. results.
may be nephritis, difficile-associated
increased in haematuria; serum diarrhoea (CDAD)
severe sickness-like and
infections. reactions. pseudomembranou
s colitis.

CLASSIFICATION
NAME OF ADVERSE CONTRAINDICATIO NURSING
& INDICATIONS
DRUGS REACTION N RESPONSIBILITY
ACTION

Generic Anti- infectives Serious UTI seizures, Contraindicated Obtain

Name: and lower headache, in patients specimen for
Ceftazidime Third- generation respiratory dizziness, hypersensitive culture and
cephalosporin tract parethesia, to drugs or sensitivity
Dosage: that inhibit cell- infection; Phelibitis, other tests before
300 ml wall synthesis. skin; thrombophebitis, cephalosporins. giving first
Promoting gynecologic, nausea, vomiting, dose.
osmotic instability CNS diarrhea, Therapy may
Route:
; usually infection. abdominal cramps Use cautiously begin while
Through IV awaiting
bactericidal rahes in patients
hypersensitive results.
Frequency::
to penicillin
q80 because of For I.M. use,
possibility of inject deep
cross- into a large
sensitivity with muscle, such
other beta- as the
lactam gluteus
antibiotics maximus or
the side of
the thigh.

Nursing care plans

 • Sister Callista Roy’s adaptive model
Roy’s adaptive model of nursing sees an individual as a set of interrelated
systems, biological, psychological, and social. The individual will try to maintain a
balance between each of this system and the outside world. However, there is no
absolute level of balance. We all strive to live with in a band where we can cope
adequately; the adaptation model is the range of adaptability within which the
individual can deal effectively with new experiences.

Assessment Diagnosis Planning Intervention Rationale evaluation

Subjective: Risk for injury After 7 days Assist with May aids in After 7 days
diagnosing of nursing
“naninilaw related to of nursing phototherapy
underlying intervention
ang mata at prematurity intervention, treatment. cause in s, the
connection with patient skin
balat ng baby the patient
the appearance color was
ko” as skin color will of jaundice. normal.
verbalized by be normal Have the infant
To allow for
the mother completely utilization of
alternate
undressed with the
pathways for
Objective: eyes and the bilirubin
excretion
Skin gonads covered
appearing To expose the
entire skin in
light yellow
phototherapy.
To protect them
from the
Sclera
constant
appearing exposure to
high intensity
light yellow
light.
Develop a
Ideally every 2
Vs taken as systematic
hours so that all
schedule of
follows: the surfaces are
turning the
exposed.s
PR:120 infant.
RR:30
T:36.3

Discharge plan
Medication
• No home medications
• Instruct to give multivitamins for optimum recovery and health

Environment
• Keep an environment conducive to health for the rapid recovery of infants.
• Emphasize the idea of keeping a clean environment to avoid infection.

Treatment
• Encourage the mother to let the baby be monitored by the health care
provider till complete recovery is met.

Health teaching
• Emphasize the need for compliance and cooperation of the mother in
helping treat the infant.
• Encourage breast feeding to help the baby gain resistance and protection
from diseases in the future.
• Emphasize that the baby is on a trust vs. mistrust stage: the needs must
be met for a healthy emotional development.

Out patient
• Remind the mother for a follow up after one week to evaluate the recovery
of the infant.

Diet
• Encourage the mother to breast feed the baby up to two years.
• An increase in feeding will help a faster gain in the weight of the baby.

Spiritual
• Encourage the mother to pray for the baby’s fast recover.
• Give words of encouragement.

Implication case

• Nursing research
This study will supply helpful information especially to health care providers,
students, nurses, and other individuals who plan to perform a study in this case.

• Nursing education
This will aid researchers and students with knowledge and information about hat
hyperbilirubinemia is; help them assess better with their own understanding and
insight about the illness and modify the wrong facts that they believe in. this
study will give them more efficient knowledge and skills about hyperbilirubinemia
and assure them a better competency regarding this illness.

• Nursing practice
This study will not only enhance own knowledge and skills of this illness, but also
instruct them the proper way to serve and cater the patient’s needs to alleviate
this condition.

Bibliography

• http://www.wrongdiagnosis.com
• http://www.pediatriconcall.com
• http://www.bioline.org
• http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/
• http://emedicine.medscape.com
• http://www.merck.com/mmpe/