Page 831 - Saunders Comprehensive Review For NCLEX-RN

1. Withhold feedings for 24 to 48 hours from infants
believed to have suffered birth asphyxia. Breast milk
is the preferred nutrient after this time period.
2. The use of probiotics with enteral feedings and breast
milk has shown evidence of prevention of NEC.
3. Administration of corticosteroids to the mother prior
to birth to promote early gut closure and maturation
of the gut mucosa
D. Interventions
1. Hold oral feedings.
2. Insert oral gastric tube to decompress the abdomen.
3. Intravenous antibiotics
4. Intravenous fluids to correct fluid, electrolyte, and
acid-base imbalances
5. Surgery if indicated

XVII. Hyperbilirubinemia

A. Description
1. Elevated serum bilirubin level
2. Evaluation is indicated when serum levels are greater
than 12 mg/dL (180 mcmol/L) in a term newborn.
3. Therapy is aimed at preventing kernicterus, which
results in permanent neurological damage resulting
from the deposition of bilirubin in the brain cells.
B. Assessment
1. Jaundice
2. Elevated serum bilirubin levels
3. Enlarged liver
4. Poor muscle tone
5. Lethargy
6. Poor sucking reflex
C. Interventions
1. Monitor for the presence of jaundice; assess skin and
sclera for jaundice.
a. Examine the newborn’s skin color in
natural light.
b. Press a finger over a bony prominence
or tip of the newborn’s nose to press
out capillary blood from the tissues.
c. Note that jaundice starts at the head
first and spreads to the chest,
abdomen, arms and legs, and hands
and feet, which are the last to be
jaundiced.
2. Keep the newborn well hydrated to maintain blood
volume.
3. Facilitate early, frequent feeding to hasten passage of
meconium and encourage excretion of bilirubin.

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