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HYPERBILIRUBINEMIA Elevation of serum bilirubin levels is related to hemolysis of RBCs and subsequent re-absorption of unconjugated  bilirubin from the small intestines. The condition may be benign or may place the neonate at risk for multiple  complications/untoward effects. NEONATAL ASSESSMENT DATA BASE Activity/Rest Lethargy, listlessness Circulation May be pale, indicating anemia Residing at altitudes above 5000 ft Cardiomegaly; increased bleeding tendencies (hydrops fetalis) Elimination Bowel sounds hypoactive. Meconium passage may be delayed. Stools may be loose/greenish brown during bilirubin excretion. Urine dark, concentrated; brownish black (bronze baby syndrome). Food/Fluid History of delayed/poor oral feeding, poor sucking reflex. More likely to be breastfed than bottle-fed. Abdominal palpation may reveal enlarged spleen, liver. Generalized edema, ascites (hydrops fetalis). Neurosensory Large cephalhematoma may be noted over one or both parietal bones related to birth trauma/vacuum extraction  delivery. Loss of Moro reflex may be noted. Opisthotonos with rigid arching of back, bulging fontanels, shrill cry, seizure activity (crisis stage). Respiration History of asphyxia Crackles, pink-tinged mucus (pleural edema, pulmonary hemorrhages) Safety History may be positive for infection/neonatal sepsis. May have excessive ecchymosis, petechiae, intracranial bleeding. May appear jaundiced initially on the face with progression to distal parts of the body; skin brownish black in color  (bronze baby syndrome) as a side effect of phototherapy. Sexuality May be preterm, SGA infant, infant with IUGR, or LGA infant, such as IDM. Birth trauma may have occurred associated with cold stress, asphyxia, hypoxia, acidosis, hypoglycemia,  hypoproteinemia. Occurs more often in male than female infants. Teaching/Learning May have congenital hypothyroidism, biliary atresia, cystic fibrosis (inspissated bile) Family factors; e.g., ethnic descent (Asian, Greek, or Korean), history of hyperbilirubinemia in previous 
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pregnancies/siblings, liver disease, cystic fibrosis, inborn errors of metabolism (galactosemia), blood dyscrasias  (spherocytosis, glucose-6-phosphate dehydrogenase  [G-6-PD] deficiency) Maternal factors, such as maternal diabetes; ingestion of medications (e.g., salicylates, oral sulfonamides late in  pregnancy or nitrofurantoin [Furadantin]; Rh/ABO incompatibility; infectious illness (e.g., rubella, CMV,  syphilis, toxoplasmosis) Intrapartal contributing factors, such as preterm labor, delivery by vacuum extraction, oxytocin induction, delayed  clamping of umbilical cord, or traumatic delivery DIAGNOSTIC STUDIES
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