Health Promotion and Maintenance Q 65
A nurse is counseling the mother of a newborn infant with hyperbilirubinemia. Which of the following instructions by the nurse is not correct?
A. Continue to breastfeed frequently, at least every 2-4 hours.
B. Follow up with the infant's physician within 72 hours of discharge for a recheck of the serum bilirubin and exam.
C. Watch for signs of dehydration, including decreased urinary output and changes in skin turgor.
D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area.
Correct Answer: D. Keep the baby quiet and swaddled, and place the bassinet in a dimly lit area.
An infant discharged home with hyperbilirubinemia (newborn jaundice) should be placed in a sunny rather than dimly lit area with skin exposed to help process the bilirubin. Phototherapy is started based on risk factors and the serum bilirubin level on the nomogram. Bilirubin absorbs light optimally in the blue-green range (460 to 490 nm) and is either photo isomerized and excreted in the bile or converted into lumirubin and excreted in the urine. During phototherapy, the eyes of the newborn must be covered, and the maximum body surface area exposed to the light.
Option A: Frequent feedings will help to metabolize the bilirubin. Breast milk jaundice occurs late in the first week, peaks in the second, and usually resolves by 12 weeks of age. It is due to inhibition of UGT activity and a factor in breast milk with a beta-glucuronidase-like activity that deconjugates conjugated bilirubin in the intestines leading to increased enterohepatic circulation.
Option B: A recheck of the serum bilirubin and a physical exam within 72 hours will confirm that the level is falling and the infant is thriving and is well hydrated. Bilirubin levels may be assessed using a transcutaneous measurement device or taking blood for total serum or plasma level determination. Transcutaneous measurement decreases the frequency of blood tests for bilirubin but is limited by dark skin tone and if the neonate has received phototherapy.
Option C: Signs of dehydration, including decreased urine output and skin changes, indicate inadequate fluid intake and will worsen hyperbilirubinemia. Breastfeeding jaundice, also known as breastfeeding failure jaundice, occurs in the first week of life and is due to failure of adequate intake of breast milk leading to dehydration and sometimes hypernatremia. Breastfeeding failure leads to decreased intestinal motility and decreases the elimination of bilirubin in the stool or meconium.