6.3 Phototherapy, Blood Exchange Transfusion Flashcards
(22 cards)
Bilirubin metabolism
- RBC breakdown, become heme and globin protein
- Heme protein become unconjugated bilirubin
- Liver: unconjugated converted into conjugated, then excreted into bile
- GI: bacteria reduce conjugated bilirubin into urobilinogen (stool color)
Hyperbilirubinemia
Characteristics
Causes
Excessive level of accumulated serum bilirubin
Jaundice / icterus
Excessive production of bilirubin
Immature liver function
Physiologic factors (most common)
G6PD deficiency
Breastfeeding, dehydration
Risk factor of hyperbilirubinemia
Family Hx
Race
Prematurity
Delay feeding, breastfeeding (GI mobility)
Birth trauma
Blood group incompatibility, haemolytic disease
Complication of hyperbilirubinemia
Unconjugated bilirubin toxic to neurons, develop encephalopathy (deposition in brain cell)
Kerniterus= yellow staining of brain cells, cause encephalopathy
Signs of encephalopathy: depression of CNS E.g. lethargy, hypotonia, seizures
Kerniterus
慢性膽紅素腦症
NNJ
Type
Neonatal jaundice
1. Physiological jaundice
2. Pathological jaundice
3. Breast-feeding associated jaundice
4. Breastmilk jaundice
Physiological jaundice
Time
Possible cause
Most common
Occurs after 24-48 hours of life, peak level at day5-7
Possible cause: immature liver function, increase RBC breakdown, lower albumin-binding capacity
Pathophysiology jaundice
Time
Possible cause
First 24 hours of life
Possible cause: excessive RBS destruction, birth trauma, infections, metabolic disorders, ABO incompatibility
Breastfeeding-associated jaundice
Time
Possible cause
= early-onset jaundice
2-4 days of life
Possible cause: inadequate intake of breast milk due to ineffective breastfeeding, decreased fluid intake, reduce stooling(removal of unconjugated)
Breastmilk jaundice
Time
Possible cause
= Late-onset jaundice
5-7 days of life, remain for weeks
Clinically well
Cause: component of breastmilk inhabit conjugation
Diagnostic method of Hyperbilirubinemia
- SB
- TcB
Site
SB serum bilirubin
- invasive and painful, most accurate
- heel stick blood sampling
TcB Transcutaneous bilirubin
- non-invasive but less accurate
- forehead or sternum
HDN
Causes
Hemolytic disease of newborn : cause occurrence of Hyperbilirubinemia at first 24hours of life
- Ph incompatibility
- ABO incompatibility
Rh incompatibility
Prevention
Isoimmunization
Mother Rh-ve, fetus Rh+ve (affect2nd)
- First fetus stimulate maternal antibiotic production
- maternal antibiotic attack 2nd fetus RBC, cause hemolysis
- may result hydrops fetalis 胎兒水腫
Prevent by Anti-D immunoglobulin (Phogam) at 28 weeks
ABO incompatibility
Major blood group of antigens of fetus different from mother
Less severe
Diagnosis of HDN
Indirect, direct Coombs (Antiglobulin) test (IAT test)
USG
Indirect (from mother)
Direct (from newborn)
Management of jaundice infants
- Phototherapy
- Early feeding (enhanced excretion)
- Medication (IVIG for HDN)
- Exchange transfusion
Possible side effect of phototherapy
Loose stool, dehydration
Hyperthermia
Skin burn, retinal
Nursing intervention for phototherapy
- Eye with opaque mask, close eye when position eye shields (retinal, corneal damage)
- Fully exposure, except diaper (maximize skin exposure to light)
- Reposition (facilitate bilirubin clearances)
- Closely monitor temp, SB level, IO
- Ensure enough milk (hydration)
- Avoid cream lotions oil (skin burn)
ET
Exchange transfusions
Remove infants blood and replaced by donor blood
Volume of ET
determine by weight
Usually 80-85ml/kg
Complication of ET
Air embolism, thrombosis
Hypotension,
hypoglycaemia,
hypocalcaemia
Nursing role in ET
Pre, during, post
Pre: keep NPO, cross match,
prepare environment (usually under radiant warmer/ neonatal resuscitaire),
equipment e.g. blood warmer
during: closely monitor VS, skin condition, documentation (amount injection and withdrawal, duration of each half cycle)
post: VS and glucose level
Continue phototherapy
Observe umbilical vein catheter site
