INTRODUCTION Neonatal Hyperbilirubinemia or Neonatal Jaundice in newborn is one of the most common problems encountered in term newborns.

Although up to 60 percent of the term newborns have clinical jaundice in the first week of life. Hyperbilirubinemia is a condition in which there is too much bilirubin in blood. When red blood cells breakdown, 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 babys body. This is called Hyperbilirubinemia. Because of bilirubin has a pigment or coloring, it causes a yellowing of the babys 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 are yellow eyes, skin, tiredness, fatigue, light colored stools, and dark urine. 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 hyperbilirubinemia and jaundice, including (1) Physiologic Jaundice this is normal response to the babys limited ability to excrete bilirubin in the first days of life. The manifestation of jaundice is after 24 hours (2) Pathologic Jaundice this may be related to inadequate liver function due to infection or other factors. The manifestation of jaundice is within 24 hours (3) 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 and (4) Jaundice from hemolysis jaundice may occur with the breakdown of RBCs due to hemolytic disease of the newborn (RH disease), having too many RBCs or bleeding. Hyperbilirubinemia affects 60% of full-term infants and 80% of preterm infants in the first 3 days after birth. In the present study of the Department of Health (DOH), 3, 278 male newborns were screened for hyperbilirubinemia. Results show that of 3, 278, 186 screened to have a positive result. Of the 186, 65 boys had a confirmatory testing, 45 were confirmed to have hyperbilirubinemia and 20 had normal results. In the Philippines, there is a prevalence rate of 4.5% to 25.7%. This study reveals an incidence of 3.9% among male Filipinos.

CAUSES/TYPES:

Physiologic Jaundice Physiologic jaundice occurs as a "normal" response to the baby's limited ability to excrete bilirubin in the first days of life. Occurs in almost all neonates. Shorter neonatal RBC life span increases bilirubin production; deficient conjugation due to the deficiency of UGT decreases clearance; and low bacterial levels in the intestine combined with increased hydrolysis of conjugated bilirubin increase enterohepatic circulation. Bilirubin levels can rise up to 18 mg/dL by 3 to 4 days of life (7 days in Asian infants) and fall thereafter.

Breast Milk Jaundice About 2 percent of breastfed babies develop jaundice after the first week. Some develop breast milk jaundice in the first week due to low calorie intake or dehydration. Develops in one sixth of breastfed infants in the first week of life. Breastfeeding increases enterohepatic circulation of bilirubin in some infants who have decreased milk intake and who also have dehydration or low caloric intake. The increased enterohepatic circulation also may result from reduced intestinal bacteria that convert bilirubin to nonresorbed metabolites.

Jaundice from Hemolysis Jaundice may occur with the breakdown of red blood cells due to hemolytic disease of the newborn (Rh disease), having too many red blood cells, or bleeding.

Jaundice related to inadequate Liver Function Jaundice may be related to inadequate liver function due to infection or other factors.

SIGNS AND SYMPTOMS: Physiologic jaundice develops during the second or third day after birth and usually subsides in 1 to 2 weeks in full-term infants and in 2 to 4 weeks in premature infants. After this, increasing bilirubin values and persistent jaundice indicate pathologic hyperbilirubinemia. Other signs may include icteric sclera, sluggishness, poor sucking reflex, irritability, a shrill highpitched cry, and a lot more. Premature infants with respiratory distress, acidosis, and sepsis are at

greater risk for encephalopathy and the development of athetoid cerebral palsy and speech and hearing impairment.

COMPLICATIONS: y y y Cerebral Palsy Deafness Kernicterus

MANAGEMENT: 1. Initiation of Early Feeding bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins. Early feeding (either breastmilk or formula), therefore, stimulates bowel peristalsis and accomplishes this. 2. Phototherapy an infants liver processes little bilirubin in utero because the mothers circulation does this for an infant. With birth, exposure to light apparently triggers the liver to assume this function. Additional light supplied by phototherapy appears to speed the conversion potential of the liver. In phototherapy, an infant is continuously exposed to specialized light such as quartz halogen, cool white daylight, or special bleu fluorescent light. The lights are placed 12 to 30 inches above the newborns bassinet or incubator. Specialized fiberoptic blanket also have been developed and are ideal for home care. The infant is undressed except for a diaper so as much skin surface as possible is exposed to light. 3. Home Phototherapy it is primarily used for decreasing physiologic jaundice rather than that associated with blood incompatibility. It has the advantage of allowing for uninterrupted contact between the parents and the newborn and therefore has the potential to aid bonding. Parents must understand the importance of the therapy, the lights must be a full 12 inches away from an infant to prevent burning, an infant must continuously wear eye patches and a diaper during phototherapy to protect the retinas and the ovaries or testes, and bilirubin levels shouls be assessed approximately every 12 hours. 4. Exchange Transfusion before the procedure, the babys stomach is aspirated to minimize the risk of aspiration from the manipulation involved. The umbilical vein is

catheterized as the site for transfusion. The procedure involves alternatively by drawing small amounts (2 to 10 ml) of the infants blood and then replacing it with equal amounts of donors blood. The blood is exchange slowly to prevent alternating hypovolemia. This can make an exchange transfusion a lengthy procedure of 1 to 3 hours. At the end of the procedure, using the last specimen (especially calcium), glucose determination, and blood cultures are taken. It may need to be repeated because additional unconjugated bilirubin from tissue moves into the circulation after the initial exchange.