Introduction:
Neonatal jaundice is one of the most common clinical conditions encountered in child health nursing and affects approximately 60% of term infants and 80% of preterm infants.
It is characterized by a yellowish discoloration of the skin and sclera caused by elevated serum bilirubin levels, commonly referred to as hyperbilirubinemia.
Effective nursing management is a cornerstone of neonatal care and plays a vital role in preventing serious complications such as kernicterus, which can result in permanent brain damage.
This responsibility requires nurses to actively initiate, maintain, and monitor the infant’s clinical progress through skilled assessment and timely interventions.
or aspiring nursing professionals who wish to build a strong foundation in neonatal and pediatric care, choosing the right educational institution is equally important. Enrolling in a reputed nursing college in Jaipur, such as Biyani Nursing College, can provide students with quality academic training, clinical exposure, and professional mentorship to excel in child health nursing.
This blog presents a goal-directed approach to help nursing students build trusting relationships with families while delivering high-quality neonatal care.
Defining Neonatal Jaundice
Neonatal jaundice is a patient-centered clinical manifestation in which the newborn’s liver is unable to process bilirubin at the rate it is produced.
It is more than a visual observation; it represents a professional process of assessment and data collection.
Although often physiological in origin, neonatal jaundice is patient-specific and requires nurses to promote healing and growth through evidence-based practice.
Mastery of neonatal jaundice management remains a fundamental clinical skill for pediatric nurses to ensure patient safety and optimal outcomes.
Types of Neonatal Jaundice
a) Physiological Jaundice
This is the most common type and typically appears after 24 hours of life.
- Caused by liver immaturity and increased breakdown of fetal red blood cells.
- Usually peaks between the 3rd and 5th day of life.
- Gradually subsides as liver function matures.
b) Pathological Jaundice
This form is considered a medical emergency in nursing practice.
- Appears within the first 24 hours or persists beyond two weeks.
- May result from Rh or ABO incompatibility, infection, sepsis, or metabolic disorders.
- Requires close monitoring as bilirubin levels can rise rapidly to dangerous levels.
c) Breastfeeding and Breast Milk Jaundice
Breastfeeding jaundice is usually related to suboptimal intake during the first week of life, leading to dehydration and reduced bilirubin excretion.
Breast milk jaundice typically appears between weeks 2 and 5 and is thought to be caused by substances in breast milk that interfere with bilirubin metabolism.
Key Components of Assessment
Physical Assessment
Nurses should inspect the infant in natural daylight whenever possible.Blanching the skin over bony prominences can help identify jaundice. A yellow discoloration appearing after pressure release indicates jaundice.Cephalocaudal progression should be noted, as yellowing that moves from the face toward the trunk and lower extremities reflects rising bilirubin levels.
Clinical Vigilance
Neurological Assessment: Monitor for drowsiness, irritability, high-pitched crying, or poor sucking reflex, which may indicate early bilirubin toxicity.Elimination Patterns: Record stool frequency and color. Black or seedy stools indicate effective bilirubin excretion.
Nursing Interventions
I. Phototherapy Management
- Maximizing Exposure: The infant should wear only a diaper to ensure maximum skin exposure.
- Eye Protection: Soft eye patches must be used to protect the retina and removed during feeding to promote bonding.
- Positioning: Reposition the infant every 2–3 hours to ensure uniform light exposure.
II. Nutritional and Hydration Support
- Frequent Feeding: Encourage feeding every 2–3 hours to promote bowel movements and bilirubin elimination.
- Daily Weights: Monitor weight daily to detect dehydration, particularly during phototherapy.
Barriers to Avoid (Non-Therapeutic Actions)
- False Reassurance: Avoid dismissive statements such as “It’s just a tan,” as they undermine parental concerns.
- Application of Lotions: Do not apply oils or lotions, as they may cause skin burns under phototherapy lights.
- Medical Jargon: Avoid complex terminology without explanation. Use clear, simple language.
Role of Nurses in Therapeutic Communication
I. Establishing Rapport and Trust:
Introduce yourself clearly, explain your role, and outline the treatment goals.Respect family privacy and handle the newborn with dignity and honesty.
II. Parental EducationExplain treatments such as phototherapy or biliblankets using simple language. Apply the teach-back method to confirm understanding.
III. Demonstrating Empathy and Support
Acknowledge parental emotions: “I can see you are worried; it can be frightening to see your baby under the lights.” Use supportive non-verbal communication, such as sitting at eye level during discussions.
IV. Documentation and Advocacy
Document the infant’s response to phototherapy, treatment duration, and parental concerns.Record parental statements in their own words when possible.Act as an advocate by promptly reporting any changes in skin color or neurological status to the physician.
Conclusion
Therapeutic nurse-patient relationships in neonatal care are built on effective communication and clinical competence.Managing neonatal jaundice is not merely a soft skill but a critical nursing responsibility that directly impacts newborn health.Future nurses must intentionally apply structured assessment techniques and compassionate communication to deliver holistic and family-centered care.
Blog By:
Mrs. Urvashi
Assistant Professor, Department of Nursing
Biyani Group Of Colleges
