Nursing 209

N209: Reproductive Health Study Guide

Bilirubin Conjugation • RBCs have shorter life span in newborns; more breakdown • Elimination of bilirubin is done by the placenta and the mother’s liver in utero • Bilirubin is the result of hemolysis of RBCs, which occurs normally after birth • Indirect bilirubin: Unconjugated and fat soluble • Direct bilirubin: Process of unconjugated bilirubin conversion in liver and reticulocyte system o Water-soluble for entry into the GI system, with bile for excretion through urine and feces via kidneys o In adults, bilirubin is further broken down by bacteria and digestive enzymes Jaundice (Icterus) • Due to immaturity of the liver at birth, bilirubin cannot be conjugated as quickly as needed • Unconjugated bilirubin is deposited in skin and mucous membranes • Kernicterus: Increased blood levels of bilirubin, resulting in permanent brain damage • Total bilirubin: Unconjugated and conjugated bilirubin • In most newborns, jaundice develops over 2-3 days and resolves within one week • Risk factors for jaundice development: o ABO incompatibility o Prematurity o Pitocin o Gestational diabetes o Birth trauma with injury (cephalohematoma) o TORCH infection (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes Simplex Virus) • Causes of jaundice: o Bilirubin overproduction: RH or ABO incompatibility, drugs, trauma at birth, breast milk, or delayed cord clamping o Decreased conjugation of bilirubin: Hypothyroidism, breastfeeding, and physiologic jaundice o Impaired bilirubin excretion: Biliary obstruction, sepsis, chromosomal (18 and 21) abnormalities, and drugs • Treatment of jaundice: o Phototherapy: The most common treatment  Light is used to change unconjugated bilirubin into a form that can be excreted in urine  Newborn is undressed with eyes and genitals covered o Exchange transfusion: Used when bilirubin level is high and continues to rise despite phototherapy  Gradual removal of newborn blood with donor replacement over 2-4 hours

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