In: Nursing
CASE STUDY 2:
Sammy is a newborn boy at 32 hours of life. His birth weight was 8 pounds. He was born via normal spontaneous vaginal birth at 40 weeks of gestation to a 26-year-old G1. There were no maternal prenatal issues. Labor and delivery were complicated by a prolonged second stage of labor, which eventually progressed to spontaneous birth. The Apgar scores were 6 and 8, and the infant was taken to the nursery for an observation period; he received IV fluids but did well and so was discharged to routine care in the mother’s room at 12 hours of life. Sammy was noted to have facial bruising and a cephalhematoma, which were attributed to the prolonged second stage of labor. All newborn blood work was normal. The group B strep culture was negative. Maternal blood type is A positive. Exclusive breastfeeding was initiated at 12 hours of life. On physical examination, Sammy has some jaundice evident on the chest and torso.
1. What risk factors does Sammy have for hyperbilirubinemia?
2. The pediatrician orders a bilirubin level, and the total serum bilirubin level is 7 mg/dL. A repeat level is ordered in 8 hours. Does this result indicate a dangerous level of hyperbilirubinemia?
3. What are the risks to the newborn with elevated bilirubin levels?
4. Sammy’s repeat total serum bilirubin was 5 mg/dL at 40 hours of life, and the pediatrician has given discharge orders for this evening when Sammy will be 48 hours old. What education is appropriate for Sammy’s parents at this time regarding jaundice?
NO PHOTOS PLEASE
Question 1.
Solution:
The following are the risk factors associated with the hyperbilirubinemia in Sammy.
1. Any kind of severe trauma during the birth including cephalohematoma, bruising, instrumented delivery procedures
2. Associated with infection “TORCH" that signify Toxoplasmosis, Other Agents, Rubella Cytomegalovirus and Herpes Simplex virus infection.
3. Prematurity in development of body
4. Excess weight loss after birth
5. Polycythemia
6. Any siblings with hyperbilirubinemia
Question 2.
Solution:
Normal indirect bilirubin within first 24 hours of birth must be under 5.2 mg/dL although many new born have a bilirubin level of more than 5mg/dL. Hence there are risks involved as the bilirubin level is much higher than normal in case of Sammy; a repeat test after 8 hrs may be the final conclusion whether Sammy is having a dangerous level of hyperbilirubinemia as the level of bilirubin becomes lower constantly with time.
Question 3.
Solution:
Though in most cases jaundice may disappear within 2-3 weaks after birth, sometimes it persists for more than 3 weaks owing to some underlying diseases. Herein high levels of bilirubin can put a baby at high risk for cerebral palsy, deafness, Kernicterus or other forms of brain damages eventually.
Question 4.
Solution:
The most important education for the Sammy’s parents include
1. Breastfeeding must be done in very short intervals. 8-12 times should be breastfeed in every 24 hours as this reduces the bilirubin level in newborn.
2. Monitor the skin or the whites of the eyes that is turning yellow.
3. Watch the baby for any new sign of developing jaundice.
4. If jaundice is getting worse the yellow colour from the eye coming down from the eye to face and subsequently up to feet.