2.  The yellowing of the skin and eyes due to the build up of bilirubin in the blood stream.  Bilirubin is produced during the breakdown of RBCs in the bloodstream. Normally, bilirubin passes through the liver and is excreted as bile through the intestines.  Hepatic excretory capacity is low both because of low concentrations of the binding protein ligandin in the hepatocytes and because of low activity of glucuronyl transferase, the enzyme responsible for binding bilirubin to glucuronic acid. It is common for newborns to experience Jaundice because the liver is still immature so it cannot excrete bilirubin at the rate it is produced.

3.  Physiological Jaundice: peaks between days 2 and 4 of life, and normally leaves the blood stream between 1-2 weeks of life. Bilirubin levels usually peak at 5-6 mg/dl on the 3 rd day.  Jaundice in prematurity: premature infants are at high risk for having high bilirubin levels simply because the prematurity of the liver, making is more difficult to excrete the bilirubin.  Breastfeeding: breastfeeding jaundice is usually not related to the milk itself but may be due to the lack of milk production. Only 1-2% of breast milk jaundice is related the actual breast milk. Breast milk jaundice can happen early, within the first 2-4 days of life, or late between days 4 and 7 of life, and normally resolves over 3 – 12 weeks of life.  Blood group incompatibility (Rh or ABO problem): this may happen if the baby has a different blood type than mom. The mother’s blood produces antibodies against the baby’s blood and begins to destroy the RBC’s, which increases the bilirubin in the blood stream. This may be prevented if the mother is given the Rh immune globin to prevent the antibodies from developing.

4.  Underlying Conditions : Disorders of the digestive system that may interfere with the ability to process and eliminate bilirubin. Some of these conditions include disorders that are present at birth, including problems with the liver and bile ducts and blockage of the bowel.  Infection. Hepatits, toxoplasmosis, and rubella can affect liver function, and allow build up of bilirubin.

5.  Transcutaneous bilirubin (TcB): this is the least invasive method to determine if further studies need to be done. They are done at 6-hour intervals, during the first 96 hours after birth in a newborn greater than 35 weeks. Blood Values: Total / direct bilirubin will be done when the TcB is greater than 15. Direct bilirubin: 0 to 0.3 mg/dL Total bilirubin: 0.3 to 1.9 mg/dL

6.  Kernicterus: brain damage as a result of excessive bilirubin in the bloodstream. The levels are so high that the bilirubin circulates in the brain, causing permanent damage.  Signs and symptoms:  Extreme lethargy  High- pitched cry  Increased muscle tone  Arching of the back  Fever  Treatment: Exchange transfusion

7.  This is a life- saving procedure done in a small percent of cases to prevent kernicterus in Jaundice babies.  The infant’s blood is slowly withdrawn, about 5 to 20 mL at a time, depending on the patient’s weight, and an equal amount of fresh blood flows into the patient's via two accesses. This cycle is repeated until the correct volume of blood has been replaced.  Levels are reevaluated to assess further transfusion.

8.  Photothearapy: is used to treat infants with high levels of bilirubin in the bloodstream by using light waves. These light waves are absorbed by the skin and blood and change bilirubin into products that can pass through their system.  For phototherapy to be effective the infant should be wearing only a diaper and eye shields.  Be sure the infant is being properly hydrated by way of IV fluids or PO.

9.  If mom is breast feeding encourage her to feed as much as possible (8-12 times per day), and keep track of the elimination pattern to assure proper feeding.  Inform parents to place baby’s crib or swing near a window for short periods of time, the sun helps in absorb the pigmentation.  Teach warning signs of kernicterus.

10.  Burns, C. Dunn, A., Brady, M., Starr, N., & Blosser, C. (2009). Pediatric Primary Care (4th Ed). St. Louis: Saunders Elsevier  Medline Plus (2009) Exchange Transfusion, retrieved on May 24, 2010, from: http://www.nlm.nih.gov/medlineplus/ency/article/002923.htm  Kids Health (2005) Jaundice in Healthy Newborns, retrieved on May 25, 2010, from: http://kidshealth.org/parent/pregnancy_newborn/common/jaundice.html