Nursing interventions in treating unconjugated hyperbilirubinemia in newborn infants

Nursing interventions in treating
unconjugated hyperbilirubinemia
in newborn infants

1. On first day, the vital signs of Maria were: Temperature 37, Heart rate 130-155, Respiratory
rate 32-55, SpO2 99% and pain N-PASS 0. She was calm, feeding well every 4 hours, had
soft flat fontanelles, with intact reflexes, normal cardiac and respiratory signs. Her first stool
was normal with a little yellowish coloring in the night, with normal passage of colorless
urine and having pink skin and moist mouth. Her weight was 4.5kg, and length 52cms.
The vital signs from the second day showed a decline in some features. Her temperature was
on the incline at 37.2, Heart rate 165 above normalcy, Respiratory rate 44, and N-PASS at 5
suggesting irritability. She was less comfortable, showing clear signs of irritation and crying
at pitched voice, having sunken yet soft fontanelles suggesting dehydration (Mansor et al.,
2012).
This was more closely observed upon dry mucous membranes in mouth, which deviated from
normal. She was dehydrated, passed little urine and had yellow colored stool. Although her
skin was clean dry, in place of pink coloration she was starting to have a yellow tint on her
face, moving downwards towards her bilateral nipple line, which was early signs of
developing neo-natal jaundice (Maisels et al., 2014). Upon weighing, she had decreased in
weight and currently stood at 4.25kg with decline of 250 grams, implicating abnormal
conditions. Moreover, upon talking with parents, it was understood that Maria had not been
feeding well on breast milk, and was tired, not latching to nipples properly and was irritated.
All the signs show abnormal trends towards developing jaundiced tendencies, with
drowsiness, poor feeding, coloration in stool, yellow tint in skin, irritability, dehydration and
decrease in weight (Amos, Jacob & Leith, 2017).
2.
Situation (S) Maria is a 48 hour baby, with gestation period >38 weeks, showing
abnormal signs in some vital stats from the 2nd day of life. She is
dehydrated, has yellow stool and tint in skin, drowsy, irritated, dehydrated
mouth, less urine discharges, and decline in birth weight.
Background (B) Maria’s mother had been 2 times pregnant before with 2 abortions, and

Maria was a vaginal delivery case. Her APGAR score 1 minute after birth
was 8 and 9 after 5 minutes. She was 4.5kgs, 52cms length and head
circumference 36cms. She has blood group O negative like her mother. Her
mother had intake of Selective Serotonin Reuptake Inhibitor
Antidepressants like Fluoxetine before pregnancy along with RhoGam
during the 28th week. All her reflexes are normal, with good cardio and
respiratory signs, no birthmark, bruising or lesions.
Assessment (A) Upon assessment she is dehydrated, with sunken flontanelles, dry mouth
and less urine discharge. Stool is yellow, along with skin color. She is
drowsy, irritated, and not feeding properly (Whyte, 2012). Her weight has
decreased and she is lethargic. Assessment stats signify high chances of
unconjugated hyperbilirubinemia.
Recommendation
(R)
Show pediatrician the abnormal signs and get checked immediately, along
with checking for blood serum levels and bilirubin levels, and further
postponing discharge for a few days, until vital-stats are normal.
3. Maria’s hyperbilirubinemia risk level according to Bhutani nomogram is High Intermediate
Risk Zone (Bhutani, Srinivas, Castillo Cuadrado, Aby, Wong, et al., 2016).

Figure: Maria’s risk factor
Source: ("Hyperbilirubinemia management guidelines", 2019)
Figure: Bhutani nomogram for 2004 AAP, Maria’s Record
Source: ("Hyperbilirubinemia management guidelines", 2019)