Hyperbilirubinemia and neonatal jaundice.

Jaundice is a common physiologic problem seen in both term and preterm infants. Normal transitional changes in bilirubin metabolism lead to physiological jaundice in many infants. In some infants these normal changes at birth may be exaggerated, such as occurs with immaturity, or may interact with health alterations (pathologic jaundice), resulting in the accumulation of excess bilirubin and development of hyperbilirubinemia. Caregivers must appreciate the processes and the basis for physiologic jaundice and hyperbilirubinemia and recognize infants at risk for these disorders. This article reviews neonatal bilirubin metabolism as a basis for understanding the causes and treatment of physiologic jaundice and hyperbilirubinemia arising from either physiologic or pathologic causes. Patterns of bilirubin in breast fed infants are discussed along with other issues related to breast feeding and jaundice. Treatment of hyperbilirubinemia and implications for nursing assessment and management of infants under phototherapy are also described.