Title Zdravstvena njega dojenčeta s hiperbilirubinemijom
Title (english) HEALTH CARE OF INFANTS WITH HYPERBILIRUBINEMIA
Author Dragica Malenica
Mentor Vjekoslav Krželj (mentor)
Committee member Diana Aranza (predsjednik povjerenstva)
Committee member Mario Podrug (član povjerenstva)
Committee member Vjekoslav Krželj (član povjerenstva)
Granter University of Split (University Department of Health Studies) Split
Defense date and country 2021-02-01, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Nursing
Abstract Nakon rođenja djeteta uslijed pojave hiperbilirubinemije kao povećane koncentracije serumskog bilirubina najvažnije je razlučiti radi li se o fiziološkoj ili pak patološkoj hiperbilirubinemiji. Prisutnost hiperbilirubinemije razotkrivamo pojavom žućkastog obojenja kod djeteta koje prvo zahvaća bjeloočnice, a zatim se širi tijelom prema nogama. Kako bi se ustanovila vrsta i potrebno liječenje najbitniji parametar kojim se neonatolozi vode je vrijeme pojave žutice. Žuticu koja se javlja u prvih 24 sata ili traje više od tjedan dana u nedonešenog ili dva tjedna u donešenog djeteta potrebno je pomno pratiti i liječiti kako ne bi došlo do razvoja kernikterusa nakon prodiranja nekonjugiranog toksičnog bilirubina u bazalne ganglije i jezgre moždanog debla. Takva hiperbilirubinemija naziva se patološkom. Patološka hiperbilirubinemija može biti konjugiranu i nekonjugiranu. Konjugirane (direktne) hiperbilirubinemije za razliku od nekonjugiranih uvijek su patološke, a njihov uzrok nastanka su oštećenja hepatocita ili različite opstrukcije žučnih vodova. Nekonjugirane hiperbilirubinemije razlog su nastanka mnogih sindroma kao što je Gilbertov sindrom. Kernikterus kao najgori ishod koji može nastati iz patološke žutice rijedak je i nepredvidiv, a dovodi do mnogih neurorazvojnih poteškoća kod preživljene dojenčadi. S druge strane fiziološka žutica kao benigna prolazna pojava manifestira se nakon 72 sata života novorođenčeta i nestaje do kraja tjedna. Uz navedene vrste hiperbilirubinemije postoji još jedna karakteristična vrsta žutice koja se pojavljuje nakon poroda a naziva se laktacijska žutica. Dijelimo je na ranu i kasnu, a srž njenog nastanka smatra se nedostatak prisutnosti enzima glukuronidaze te pregnan-3α,20β-diola i neesterificirane masne kiseline u majčinom mlijeku. Dijagnoza hiperbilirubinemije obuhvaća TSB test kao zlatni standard i TcB test kao jednostavniju, bržu i neinvazivnu metodu koja koristi uređaj transkutani biliruinometar. Visoke vrijednosti TSB-a potrebno je umanjiti te spriječiti neurotoksičnost bilirubina standardnim metodama liječenja koje uključuju fototerapiju i eksangvinotransfuziju te popratnu farmakološku potporu fenobarbitolom. Uloga medicinske sestre kod hiperbilirubinemije proteže se od labaratorijskih pretraga preko edukacije majke do skrbi i njege za dijete kod postupaka snižavanja bilirubina. Ključna je i njena uloga pri planiranju i provođenju zdravstvene njege kroz sestrinske dijagnoze i intervencije.
Abstract (english) After the birth of a child due to the appearance of hyperbilirubinemia as an increased concentration of serum bilirubin, it is most important to distinguish whether it is physiological or pathological hyperbilirubinemia. The presence of hyperbilirubinemia is revealed by the appearance of a yellowish discoloration in a child that first affects the sclera and then spreads through the body towards the legs. In order to establish the type and treatment required, the most important parameter used by neonatologists is the time of onset of jaundice. Jaundice that occurs in the first 24 hours or lasts more than a week in a premature or two weeks in a preterm infant should be closely monitored and treated to prevent the development of kernicterus after unconjugated toxic bilirubin enters the basal ganglia and brainstem. Such hyperbilirubinemia is called pathological. Pathological hyperbilirubinemia can be conjugated or unconjugated. Conjugated (direct) hyperbilirubinemias, unlike unconjugated ones, are always pathological, and their cause is hepatocyte damage or various bile duct obstructions. Unconjugated hyperbilirubinemias are the cause of many syndromes such as Gilbert's syndrome. Kernicterus as the worst outcome that can result from pathological jaundice is rare and unpredictable, and leads to many neurodevelopmental difficulties in surviving infants. On the other hand, physiological jaundice as a benign transient occurs after 72 hours of life of the newborn and disappears by the end of the week. In addition to these types of hyperbilirubinemia, there is another characteristic type of jaundice that occurs after childbirth and is called lactational jaundice. It is divided into early and late, and the core of its occurrence is considered to be the lack of the presence of the enzyme glucuronidase and pregnan-3α, 20β-diol and non-esterified fatty acids in breast milk. The diagnosis of hyperbilirubinemia includes the TSB test as the gold standard and the TcB test as a simpler, faster, and noninvasive method using a transcutaneous biliruinometer device. High TSB levels should be reduced and bilirubin neurotoxicity prevented by standard treatments including phototherapy and exanguinotransfusion and concomitant pharmacological support with phenobarbitol. The role of the nurse in hyperbilirubinemia extends from laboratory tests through maternal education to child care and nursing in bilirubin lowering procedures. Its role in planning and implementing health care through nursing diagnoses and interventions is also crucial.
Conclusion: A form of hyperbilirubinemia in infants needs to be recognized in order to initiate timely treatment and avoid consequences such as kernicterus. In addition to neonatologists, nurses are also involved in this process.
Keywords
Hiperbilirubinemija
kernikterus
medicinska sestra
žutica
Keywords (english)
Hyperbilirubinemia
kernicterus
nurse
jaundice
Language croatian
URN:NBN urn:nbn:hr:176:184870
Study programme Title: Nursing (university/undergraduate) Study programme type: university Study level: undergraduate Academic / professional title: sveučilišni prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva (sveučilišni prvostupnik/prvostupnica (baccalaureus/baccalaurea) sestrinstva)
Type of resource Text
File origin Born digital
Access conditions Open access Embargo expiration date: 2021-07-02
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Created on 2021-02-03 09:56:34