(5) High-pitched cry and diminished or absent moro and sucking reflex -
with ensuing neurologic damage.
(6) Hyperirritability, hypertonia, seizures, and opisthotonos (tetanic spasm
resulting in an arched hyperextended position of the body-with advanced neurological
(7) Cerebral palsy, seizure disorders, deafness, and death - with
permanent neurological damage.
(1) Kernicterus-a yellowish discoloration of specific areas to brain tissues
by unconjugated bilirubin. This accumulation of bilirubin rises to toxic levels and is
deposited in the brain causing brain damage.
(2) Nephrotoxic bilirubin-this refers to the bilirubin level in the blood being
toxic and is, therefore, destructive to kidney cells.
d. Treatment/Nursing Care.
(1) Early feedings. This is important to stimulated digestive processes in
the intestines which are necessary to establish bacterial flora and to decrease
enterohepatic circulation of bilirubin.
(2) Phototherapy. This allows for the utilization of alternate pathways for
bilirubin excretion. Lights break down the pigment in the skin so that it can be excreted.
The nurse must:
(a) Monitor the infant's temperature.
Apply meticulous eye care. Ensure patches are in place over the
Monitor I&O, skin turgor, daily weights, and skin breakdown.
(3) Albumin. This method transports bilirubin to the liver for modification.
Albumin-bound bilirubin is not able to penetrate the blood-brain barrier, which aids in the
prevention of kernicterus.
(4) Exchange transfusion. This is the most direct method of eliminating
bilirubin. Transfusion is generally reserved for more severe cases secondary to
complications. The goal is to exchange the neonate's blood with fresh donor blood.