Yellow Yusuf — Newborn Hyperbilirubinemia & Phototherapy
Jaundice head-to-toe by day 2-3 — eyes covered, skin bare under lights
Yusuf is born healthy but by day two his skin has taken on a golden tint that starts at his face and creeps toward his toes. His mother worries he looks more yellow every time she checks.
Yusuf's immature liver cannot conjugate bilirubin fast enough, so unconjugated bilirubin builds up and stains his skin and sclera yellow, progressing head to toe. Physiologic jaundice appears after 24 hours of age; jaundice within the first 24 hours is pathologic and needs urgent workup. Phototherapy converts bilirubin into a water-soluble form the body can excrete, but the eyes must be shielded and skin exposed as much as possible. Untreated severe hyperbilirubinemia can cross into the brain and cause kernicterus, a permanent neurologic injury.
Read Yellow Yusuf's full story →The story arc
The setup
Yusuf is born at 38 weeks, breastfeeding well but slowly establishing a feeding pattern in his first day of life.
The turn
On day two, his face and chest take on a yellow tint that was not there at birth.
The crisis
By day three his total bilirubin is climbing rapidly and now his arms and legs are yellow too, and he is feeding poorly and difficult to arouse.
The save
Yusuf is placed under phototherapy with his eyes shielded and only a diaper on, he is fed frequently to promote bilirubin excretion in stool, and his bilirubin is trended every few hours.
NCLEX study section — Newborn Hyperbilirubinemia & Phototherapy
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.