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HAIZEL RABOY
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Hyperbilirubinemia
● It refers to an excessive level of accumulated bilirubin in the blood
and is characterized by jaundice or icterus, a yellowish discoloration
of skin and other organs.
● It is a common finding in the newborn and in most instances is
relatively benign. However, in extreme cases, it can indicate a
pathologic cause.
● It may result from increased unconjugated or conjugated bilirubin. Healthy With Jaundice

Etiology S&S Risk Factors

● Premature birth ● Yellowish color of the NB’s Maternal factors
● Breastfeeding skin & whitish of the eyes ● Blood type ABO or Rh incompatibility
● Significant bruising during ● Poor feeding ● Breastfeeding
birth ● Lack of energy ● Drugs: diazepam (Valium), oxytocin (Pitocin)
● Jaundice from Hemolysis ● Lethargy/ excessive sleepiness ● Ethnicity: Asian, Native American
● Jaundice caused by poor liver ● Changes in muscle tone (either ● Maternal illness: gestational diabetes
function listless or stiff with arching of  
● Genetic predisposition to the back) Neonatal factors
increased production (Native ● High-pitched crying ● Birth trauma: cephalohematoma, cutaneous bruising, instrumented
Americans, Asians) ● Seizures delivery
● Some disease states (e.g. ● Drugs: sulfisoxazole acetyl with erythromycin ethylsuccinate
Glucose -6 phosphatase (Pediazole), chloramphenicol (Chloromycetin)
dehydrogenase (G6PD), ● Excessive weight loss after birth
hypothyroidism, infant of a ● Infections: TORCH
diabetic mother) ● Infrequent feedings
● Male gender
● Polycythemia
● Prematurity
● Previous sibling with hyperbilirubinemia
 Tests & Exams
● Direct & Indirect bilirubin levels
Hyperbilirubinemia
● RBC counts
● Blood type & test in for Rh Incompatibility (Coomb's
Test) Phototherapy
● Indirect Coomb s Test – measures amount of Rh
positive antibodies in the mother’s blood A medical treatment that
● Direct Coombs Tests – reveals antibody coated Rh 1 involves exposure of florescent
positive in the NB light bulbs, sunlight, and light
emitting diodes.
Nursing Management
● Assess any changes in behavior & observe evidence It is used to new born jaundice
of bleeding 2 by lowering the bilirubin levels
● Check the NB for jaundice q2 & record observations in blood through process called
● Instruct the mother to breastfeed photo-oxidation.

Diagnoses
● Increased body temperature r / t effects of
phototherapy Fiber Optic Blanket
● Fluid volume deficit r / t inadequate fluid intake
● Impaired nutrition r/t poor feeding 1 AKA Biliblanket
● Risk for injury
● Anxiety: Parent r/t treatment
A portable phototherapy device
2
Treatment consisting of a fiber-optic pad
and a portable illuminator for
● Phototherapy the treatment of neonatal
● Fiber optic blanket jaundice (hyperbilirubinemia) in
● Exchange transfusion the home.
● Family Support
 Sudden Infant Pathophysiology

Death Syndrome ENVIRONMENTAL

FACTORS

Sleeping face
GENETIC FACTORS

5-HTT
down or side polymorphism
AKA COT/ CRIB
DEATH Smoking ANS polymorphism

- SUDDEN,
Impaired
UNEXPLAINABLE DEATH Thermal Autonomic Cardiac ion
DURING 1ST YEAR O LIFE Stress Regulation channelopathy

Complement/
Soft Bedding Interleukin
polymorphism

SIDS or crib death is the sudden, unexplained death of a SIDS

seemingly healthy infant during sleep, in which a thorough post-
mortem examination does not show a cause. It usually happens
anytime in the 1st year of life. The cause of SIDS is still
unknown.
S&S
● Apneic, cyanotic, lifeless
● Frothy, blood-tinged fluid in the mouth or
nose
● Diaper is field with urine and stool
● Hands maybe clutching the sheets
Risk Factors
● Sex: Boys are slightly more like to die of SIDS
● Age: Infants are most vulnerable between 2nd – 4th months of life
● Second hand smoke: Infants who live with smokers have higher risk of SIDS
● Prematurity: Being born early or having low birth weight have a higher risk of
SIDS
● Maternal: Mother is younger than 20, smokes cigarettes, used drugs, inadequate
prenatal
 Nursing Management Prevention
When dealing with a family whose infant has just died of
SIDS:

● Be aware that assessment, planning, and implementation

related to the parents’ needs should begin as soon as they
arrive in the emergency department.
● Provide the family with a room and a staff member who Always place Keep baby in
Keep your
can stay with them. Support them and reinforce the act that baby on his/her mom’s room,
baby from
death wasn’t their fault. back to sleep but in a
overheating
● Stay calm and let the parents express their feelings. separate area
● Prepare the family for how the infant will look and feel.
● Let the parents touch, hold, and rock the infant, if desired.
Allow them to say goodbye.
● Contact spiritual advisors, significant others, support
systems, and local SIDS organization.
● Provide literature on SIDS and support groups.

Keep smoke- Consider

free zone offering a
around the pacifier to put
baby baby to sleep

Diagnosis
● Dysfunctional Grieving
● Interrupted family processing Remove Keep soft objects,
● Death anxiety everything other Use firm toys, & other loose
● Risk for complicated grieving than the mattress mattress bedding out of the
● Risk for Impaired parenting & sheet from the infant’s area
crib

Right atrium
Right ventricle
Etiology
VSD may be associated with:
● Fetal alcohol syndrome
● Down syndrome and other
Autosomal Trisomies
● Renal anomalies
● PDA and Coarctation Of The
Aorta ● Prematurity
Diagnosis
● Activity intolerance r/t
imbalance bet.
supply/demand
● Decreased cardiac output r/t
heart defect
● Risk for injury r/t surgery
● Risk for delayed growth &
development r/t failure to gain
weight
● Ineffective breathing pattern
Acya
Ventricular
notic Septal
Left atrium
Pulmonary artery
Defect (VSD)
VSD, the most common type of congenital cardiac disorder seen, accounts for
Left ventricle about 30% of all instances of congenital heart disease, or about 2 in every 1000
live births (Fulton & Freed, 2008). With this defect, an opening is present in
the septum between the two ventricles. Because pressure in the left ventricle is
greater than that in the right ventricle, blood shunts from left to right across the
S&S septum (an acyanotic disorder). This impairs the effort of the heart because
blood that should go into the aorta and out to the body is shunted back into the
● Shortness of breath Paleness pulmonary circulation, resulting in right ventricular hypertrophy and increased
● Rapid reathing pressure in the pulmonary artery.
● Failure to gain weight Complications
● Fast heart rate
● Sweating ● Aortic Insufficiency (leaking of the valve that separates the left ventricle
● Frequent respiratory infections from the aorta)
● Damage to the electrical conduction system of the heart during surgery
(causing an ● irregular or slow heart rhythm)
● Delayed growth and development (failure to thrive in infancy)
Exam & Tests ● Heart Failure
● Infective endocarditis (bacterial infection of the heart)
● Chest X-ray
● Pulmonary hypertension (high blood pressure in the lungs) leading to failure
02 ● Magnetic Resonance Imaging
of the right side of the heart
(MRI) of the heart
● Measurement of the Electrical Treatment
Activity of the heart (EKG)
● Ultrasound of the heart ● Medications to help with heart failure
(Echocardiogram) ● Oxygen & other breathing support
● Surgery to correct the valve may be needed for children who continue to
worsen or who have more serious complications
 Acya
notic
Atrial Septal Right atrium

Defect (ASD)
Left atrium

Atrial Septal Defect

Blood passes from the left
An ASD is an abnormal communication between the two atria, allowing atrium to the right atrium
blood to shift from the left to the right atrium (an acyanotic defect). It is more
common in girls than boys (Fulton & Freed, 2008). This opening usually Right ventricle
closes around time when baby is born. If the opening does not close , the hole
called an atrial septal defect.
Etiology S&S
● ASDs happen during fetal Children with larger, more severe
development of heart ASDs, though, might have some of
● Genetic defects these sign or symptoms:
● Use of alcohol & street drugs ● Poor appetite
● Diseases such as diabetes, lupus ● Poor growth
& rubella ● Extreme tiredness
● Shortness of breath
● Lung problems and infections
Test & Exams Complications
● Chest X-ray
Larger defects :
● Electrocardiogram (EKG) Diagnosis ● Right-sided heart failure
● Doppler examination
● Activity intolerance ● Heart rhythm abnormalities (arrhythmias)
● Echocardiogram (Echo) – a
● Decreased cardiac output ● Increased risk of a stroke
picture of the heart & blood flow
● Risk for injury ● Shortened life span
through its chambers. This is often
● Risk for Decreased Cardiac Less common serious complications may
primary tool to diagnose an ASD.
Tissue Perfusion r/t surgery include:
● Right & left heart catheterization
● Risk for delayed growth ● Pulmonary hypertension
● Eisenmenger syndrome
Atrial Septal
Defect (ASD) Cardiac Catheterization

Treatment & Management

Small defects: Treated part of
● Cardiac catheterization technique vein
Large defects: Catheter
● Silastic or Darcon patch suture Varicose vein
● Open heart surgery
● Cardiopulmonary bypass

Postoperative Care
● Carefully observe the child for arrhythmias
because edema of the right atrium could interfere
with SA node function.
● Activity restrictions
● Medications like blood thinners

Prevention Cardiopulmonary Bypass

In most cases, atrial septal defects can't be
prevented. If you're planning to become pregnant,
schedule a visit with your health care provider. Oxygenator
This visit should include:
● Getting tested for immunity to rubella
● Going over your current health conditions and
medications
● Reviewing your family medical history Filter
Pump
 Cyan Healthy Ebstein’s

otic
Ebstein’s
Ebstein’s anomaly is a rare heart
defect in which parts of the
tricuspid valve are abnormal.
The condition is congenital,

Anomaly
which means it is present from Right atrium Atrial septal defect
birth. The exact cause is
unknown.

S&S Risk Factors Right atrium

Most common: Risk factors are not clear. Some

● Blue coloration of the skin, possible ones are:
lips or nails ● Chromosomal abnormalities
Some severe cases: ● Environmental exposure Tricuspid valve
● Difficulty of breathing ● Certain medicines taken by a Displaced tricuspid valve allows
Older children: pregnant mother, such as lithium. blood back into right atrium
● Cough
● Irregular heartbeat
● Rapid breathing or shortness Diagnostics Treatment & Management
of breath ● Chest X-ray ● Regular Monitoring with regular check-ups
● Slow growth ● Echocardiogram ● Lifelong monitoring by a heart specialist will be needed.
● Fatigue Electrocardiogram
● ● Medications to ease signs and symptoms of heart failure, such as
● Fast heartbeat (EKG) drugs to prevent water retention (diuretics), to prevent blood clots, and
● Swelling ● Cardiac catheterization help restore normal heart rhythms
Complications Surgery may be indicated depending of the circumstance.
Diagnosis Mild Ebstein anomaly may not cause ● Tricuspid valve repair/ replacement
● Activity intolerance any complications. However, possible ● Closure of the atrial septal defect.
● Decreased cardiac output complications of Ebstein anomaly ● Maze procedure.
● Compromised family include: ● Leaky Valve Cone Procedure
coping ● Heart failure ● Radiofrequency catheter ablation
● Risk for injury ● Sudden cardiac arrest ● Heart transplantation
● Stroke
 Cyan
otic
It is a rare disorder accounting for only 1% to 3% of congenital heart disease,
the left ventricle is non-functional. There may be accompanying mitral or

Hypoplastic Left
aortic valve atresia. The non-functioning left ventricle lacks adequate strength
to pump blood into the systemic circulation. This causes the right ventricle to
hypertrophy as it tries to maintain the entire heart action (Alsoufi et al., 2007).

Etiology S&S Heart Syndrome

The problem develops before ● Cyanosis, or a grayish (dark-skinned
birth when the left ventricle & people) or bluish (light-skinned
Patent (open) ductus arteriosis
other structures do not grow people) discoloration of skin, lips and 1
properly, including the: nails.
● Aorta ● Sweaty, clammy or cool skin
● Entrance & exit of the ● Rapid heartbeat. ● Weak Abnormal hole between atria
ventricle pulse
2
● Mitral & aortic valves of the ● Difficulty breathing
Mitral valve
heart to fail ● Difficulty feeding 3
● Lack of energy (lethargy)
Abnormally small aortic valve
4
Abnormally small left ventricle
5
Diagnostics
During pregnancy, healthcare providers use prenatal screening tools such
as:
● Ultrasound ● Fetal echocardiogram
After the baby is born, healthcare providers diagnose the condition by
observing symptoms and examining test results. Babies may have tests,
including:
● Chest X-ray ● Echocardiogram
 Hypoplastic Left Heart
Syndrome 1 4 Norwood Procedure
Treatment & Management Superior vena cava
2 1
● Alprostadil (Prostin VR Pediatric)
● Breathing assistance
Right pulmonary artery
● I.V. fluids 2
● Prostaglandin E1 (PGE1) infusion 3
● Feeding tube
Patch placed on the top of the right
● Staged surgical repair 3 atrium
● Atrial septostomy - procedure that creates or enlarges
the opening of the atria to allow more blood flow from
right atrium to left atrium if the formamen ovale closes or 4 Shunt removed
too small.
● Norwood procedure
● Bidirectional Glenn procedure
● Fontan procedure
● Heart transplant 2
Prevention
Glenn Procedure
No obvious factors are known to
cause HLHS. However, pregnant
women are always encouraged to
1 1 New aorta sends blood to body
follow healthful habits during their
pregnancy including:
3 BT shunt sends some blood to lungs
● Avoiding alcohol and smoking 2
● Controlling any medical
conditions, such as diabetes
● Eating a healthy diet 3 Wall between atria removed
● Taking a daily prenatal vitamin
with at least 400 micrograms
(mcg) of folic acid.
 Online References:

Atrial septal defect (ASD): Symptoms, causes, tests and treatments. (n.d.). Cleveland Clinic. Retrieved April 28, 2021, from
https://my.clevelandclinic.org/health/diseases/11622-atrial-septal-defect-asd

Atrial septal defect (ASD) - symptoms and causes. (2019, December 20). Mayo Clinic. Retrieved April 28, 2021, from https://
www.mayoclinic.org/diseases-conditions/atrial-septal-defect/symptoms-causes/syc-20369715

Dennis, B. P. M. L. L. (2002, February 15). Hyperbilirubinemia in the term newborn. American Family Physician. Retrieved April 25, 2021, from https
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7E:text=Common%20risk%20factors%20for%20hyperbilirubinemia,risk%20for%20serum%20bilirubin%20elevation

Ebstein’s anomaly | boston children’s hospital. (n.d.). Boston Children’s Hospital. Retrieved April 29, 2021, from
https://www.childrenshospital.org/conditions-and-treatments/conditions/e/ebsteins-anomaly

Ebstein Anomaly—Child | winchester hospital . (n.d.). Winchester Hospital. Retrieved April 29, 2021, from
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Ebstein anomaly - diagnosis and treatment - mayo clinic. (2020, February 29). Mayo Clinic. Retrieved April 29, 2021, from https://
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Hypoplastic left heart syndrome - diagnosis and treatment - mayo clinic. (2020, December 3). Mayo Clinic. Retrieved April 29, 2021, from https
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Hypoplastic left heart syndrome (HLHS): Causes, symptoms, surgeries & more. (n.d.). Cleveland Clinic. Retrieved April 29, 2021, from https://
my.clevelandclinic.org/health/diseases/12214-hypoplastic-left-heart-syndrome-hlhs#symptoms-and-causes

Sudden infant death syndrome (SIDS) - symptoms and causes. (2020, May 20). Mayo Clinic. Retrieved April 25, 2021, from https://
www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800

Ventricular septal defect (VSD) | boston children’s hospital. (n.d.). Boston Children’s Hospital. Retrieved April 25, 2021, from https://
www.childrenshospital.org/conditions-and-treatments/conditions/v/vsd

Ventricular septal defect. (n.d.). Medline Plus. Retrieved April 25, 2021, from https://medlineplus.gov/ency/article/001099.htm