Enhancing Neonatal Nurses’ Performance Regarding Early Detection of Neurological Dysfunction among Neonates having Hyperbilirubinemia

Abstract

Neonatal hyperbilirubinemia is a unique disease of newborn with the main characteristics that yellowing of the skin, sticky membranes, sclera and other tissues of a newborn infant. Generally, it can be basically divided into two categories based on the clinical manifestations: physiological jaundice, which would subside in the short term after birth; pathologic jaundice, the neonatal jaundice of infant, aggravated with time and could not be subsided. Moreover, serious pathological jaundice could cause kernicterus which affect the development of wisdom and neurological of newborn infant in post neonatal period (Dani et al., 2015). The jaundice is usually due to unconjugated hyperbilirubinemia, which is neurotoxic and can cause kernicterus or even death in newborns. Kernicterus is characterized by bilirubin staining of the basal ganglia and involves diffuse neuronal damage. The precise blood level above which unconjugated bilirubin will be toxic for an individual infant is unpredictable. However, high incidence of kernicterus is associated with serum bilirubin levels in excess of 20 mg/dl in normal birth weight babies who are otherwise healthy. There is no cure for kernicterus, can be prevented if jaundice is recognized early and effective therapy commenced promptly (Testoni et al., 2015). Bilirubin- induced neurological dysfunction (BIND) refers to the clinical signs associated with Bilirubin toxicity (ie, hypotonia followed by hypertonia and/or opisthotonus or retrocollis). Around 55-65% the babies with BIND, presents with these features, 20-30% may display some neurologic abnormalities, and approximately 15 have no neurologic signs. Acute bilirubin encephalopathy (ABE) can divided in to 3 stages first phase (first few days of life) is characterized by decrease in alertness, hypertonia and poor feeding are the typical signs. The second phase (variable onset and duration) hypertonia of the extensor muscle is a typical sign infants present clinically with retro Collis (backward arching of the neck), opisthotonus, or both. Third phase (infants aged >1 wk).hypertonia is atypical sign (Spring & Annibale, 2014).