Question

Newborn transition to extrauterine life essentially means the neonate is adapting to life outside of the uterine environment. This adaption begins immediately as the neonate takes in his/her first breath and continues over a period of time; during this time the neonate has periods of reactivity. The events that unfold with the neonate are predictable and involve all body systems.

Baby H is between 1 to 16-hours old

Baby H was just born in the hospital. His birth weight was 3856 grams, born via normal spontaneous vaginal birth at 40 weeks of gestation; mom is a 26-year-old G1. Mom had no maternal prenatal issues; however, the second stage of labor was prolonged and required forceps assisted delivery. Group B streptococcal was negative, maternal blood type is A positive and mom has decided she wants to exclusively breastfeed Baby H. The physical exam of Baby H reveals some facial bruising and a cephalhematoma; he had a brief visit (1.5 hours) in the NICU. Apgar scores following deliver were 6 at 1 minute and 9 at 5 minutes. Baby H is on his mother’s chest while she and his father are admiring him.

Baby H 1 to 16 hours old and identify risk factors Baby H has for hyperbilirubinemia? Why are these risk factors? What are the nursing interventions associated with hyperbilirubinemia? You will respond to a second peers Baby H at 18 to 36 hours old and identify the successful steps to breastfeeding. What interventions would the nurse initiate to encourage success for the breastfeeding infant?

Answer 1

Neonatal hyperbilirubinemia is the abnormal elevated serum bilirubin levels in newborn baby which cause jaundice.It is classified into physiologic jaundice and pathological jaundice. The pathological jaundice appears within 24hours of life after birth and physiological jaundice on the third to fourth day of life.

Risk factors Baby H has for hyperbilirubinemia and the reason

The  labor was prolonged and required forceps assisted delivery during baby H delivery and the physical examination revealed some facial bruising and a cephalhematoma . The baby H was exclusively breastfeed after delivery. These two factors may put the baby in risk of hyperbilirubinemia because birth injuries , bruicing and cephalhematoma leads to increased destruction of red blood cells int he baby and increase the serum bilirubin level. The risk of hyperbilirubinemia is higher in comparing with formula fed babies due to initial feeding difficulties like poor latching or decreased milk production. This leds to dehydration and increased breakdown of red blood cells causes hyperbilirubinemia.

The nursing interventions associated with hyperbilirubinemia

• Assess the baby for poor feeding and  signs of dehydration
• Teach the mother about breast feeding techniques and assist in feeding.
• Encourage the mother to feed the baby every 2 hours and as per demand.
• encourage the mother to to wake the baby for feeding if the baby sleps continuously.
• Assess the skin color of the baby. skin texture, moist lips and mouth.
• Obtain laboratory investigations for serum bilirubin levels.
• Initiate phototherapy as per order
• Observe the baby skin and eyes every two hours during phototherapy.
• Provide education to parents regarding care of infant with hyperbilirubinemia.

Interventions to initiate  successful breastfeeding

• Assess the baby for sucking ability, poor latching
• Teach the mother about the positioning of the baby, successful latching techniques and milk pumping techniques.
• Assist the mother to feed the baby by helping in positioning the baby and following the breast pumping techniques.
• provide comfortable position with extra pillows ans support the mother during feeding.
• Encourage the mother to awake the baby if sleeping during feeding because most of the babies sleep after one to two sucking on breast which leads to poor feeding.
• teach the mother to identify infant feeding cues and feed at least 2 hourly during the first few weeks.
• Encourage the mother to offer both breast during each feeding.
• Ask the mother to identify audible and visible swallowing, sustained rhythmic sucking, relaxed arms and hands, moist mouth, and regular wet nappies which are signs of good feeding in infant.