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Pathophysiology of Hyperbilirubinemia

Hyperbilirubinemia, or jaundice, occurs when there is an excessive amount of bilirubin in the blood, causing the skin and eyes to appear yellow. It is common in newborns as their livers mature after birth. There are several types of jaundice, including physiologic jaundice which is normal and occurs after 24 hours, and pathologic jaundice within 24 hours. Treatment may include phototherapy or blood transfusions for severe cases. Nurses educate parents on signs, routine blood work, and following up with the pediatrician.

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239 views3 pages

Pathophysiology of Hyperbilirubinemia

Hyperbilirubinemia, or jaundice, occurs when there is an excessive amount of bilirubin in the blood, causing the skin and eyes to appear yellow. It is common in newborns as their livers mature after birth. There are several types of jaundice, including physiologic jaundice which is normal and occurs after 24 hours, and pathologic jaundice within 24 hours. Treatment may include phototherapy or blood transfusions for severe cases. Nurses educate parents on signs, routine blood work, and following up with the pediatrician.

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Warner 1

Cristina Warner

Sarah Holda

NRS 211-Care of Women and Neonates

29 December 2017

Pathophysiology of Hyperbilirubinemia

Hyperbilirubinemia is when there is an excessive amount of bilirubin in the blood resulting in

jaundice. It is present in up to 60% of enfants and 80% of premature babies. If a baby’s liver doesn’t

work properly after birth, a buildup of bilirubin occurs. Jaundice can present itself with yellowing of the

skin and sclera, urinating and defecating less, poor feeding, and in severe cases, brain damage or

seizures. Jaundice can appear within the first 24 hours of birth, and in rare cases, up to three months

after birth. It can be mild, not needing treatment, to very severe, where the baby needs a blood

transfusion.

Jaundice can come about in multiple ways. One of them being physiologic jaundice, which is the

most common and is considered normal. This occurs because the liver is still trying to adjust to working

on its own, and isn’t mature enough. Physiologic jaundice doesn’t occur until after the baby is a day old.

Pathologic jaundice occurs within the first 24 hours. It is caused by the abnormalities which cause RBCs

to be destroyed excessively. The bilirubin levels rise quickly right after birth, and it requires further

investigation. Breast milk jaundice is another type of jaundice which is caused by an insufficient intake.

Late onset or true breast milk jaundice may take anywhere from three weeks to three months to settle.

The cause is unknown, but it’s believed that substances in the breast milk may increase absorption of

bilirubin from the intestine or interfere with conjugation.


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Jaundice is first noticed by the yellowing of the baby’s skin and a change in the color of the

sclera. It may lead to poor feeding habits and a lack of energy. In blood tests, bilirubin levels will be

elevated. Some of the risks factors of elevated bilirubin levels include excess production of bilirubin,

decreased albumin binding cites, liver immaturity, blood incompatibility, poor feedings, and trauma.

Phototherapy (light treatment) is the most common treatment plan for jaundice. This can take

place in the patient home with follow up lab work. Parents need to make sure the infants eyes are

covered with a protective eye peace while under light. Depending on severity, some cases may lead to

hospitalization, or a blood transfusion may be necessary to reduce severe, life threatening problems. A

nurse’s responsibility is to educate and answer any questions the parents might have. They should teach

them of signs and symptoms of complications, the importance of routine blood work, and to follow up

with the Pediatrician.


Warner 3

McKinney, E. S., & Crum, K. A. (2013). Virtual clinical excursions--Obstetrics-pediatrics, for

McKinney, James, Murray, Nelson, and Ashwill: Maternal-child nursing, 4th edition:. Maryland Heights,

MO: Elsevier/Saunders.

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