{"id":15712,"date":"2022-12-16T22:46:31","date_gmt":"2022-12-17T01:46:31","guid":{"rendered":"https:\/\/www.ufrgs.br\/levi\/?page_id=15712"},"modified":"2022-12-17T08:09:06","modified_gmt":"2022-12-17T11:09:06","slug":"hiperbilirrubinemia","status":"publish","type":"page","link":"https:\/\/www.ufrgs.br\/levi\/hiperbilirrubinemia\/","title":{"rendered":"Hiperbilirrubinemia"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"15712\" class=\"elementor elementor-15712\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6d8cba2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"6d8cba2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f11dd86\" data-id=\"f11dd86\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5a86741 elementor-widget elementor-widget-image\" data-id=\"5a86741\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"1920\" height=\"476\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Banner-2022-36-2-1920x476.png\" 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\/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-1404ee2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1404ee2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-30b962a\" data-id=\"30b962a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a0a354c elementor-widget elementor-widget-text-editor\" data-id=\"a0a354c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>Publicado em 16 de dezembro de 2022.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-9c6a597 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9c6a597\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-aa020e5\" data-id=\"aa020e5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-687d2aa elementor-widget elementor-widget-image\" data-id=\"687d2aa\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"579\" height=\"491\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/coloracao-pele.png\" class=\"attachment-full size-full\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/coloracao-pele.png 579w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/coloracao-pele-300x254.png 300w\" sizes=\"(max-width: 579px) 100vw, 579px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-65498b1\" data-id=\"65498b1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-52b52cb elementor-widget elementor-widget-text-editor\" data-id=\"52b52cb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 A icter\u00edcia neonatal caracteriza-se pela eleva\u00e7\u00e3o da concentra\u00e7\u00e3o de bilirrubina (Bb) no sangue (Hiperbilirrubinemia), tornando a colora\u00e7\u00e3o da pele amarelada. A Hiperbilirrubinemia costuma ser classificada como \u201cindireta\u201d ou \u201cdireta\u201d em fun\u00e7\u00e3o do tipo de bilirrubina que desencadeia a altera\u00e7\u00e3o; isso \u00e9, por excesso de Bb n\u00e3o conjugada ou indireta (BI; BI \u00b3 2 mg\/dL), excesso de Bb conjugada ou direta (BD; BD \u00b3 1 mg\/dL) ou por ambos excessos. A BI resulta da quebra da hemoglobina, que deve ser conjugada pelas c\u00e9lulas hep\u00e1ticas do f\u00edgado para tornar-se hidrossol\u00favel e ser excretada para o duodeno por meio da bile e a BD remete \u00e0 processo infeccioso e poss\u00edvel colestase.\u00a0 A icter\u00edcia, como sinal cl\u00ednico, Figura 1, pode ser considerada uma parte da fisiologia de transi\u00e7\u00e3o do per\u00edodo intrauterino para o per\u00edodo neonatal; e, geralmente \u00e9 identificada quando a taxa de Bb total (BT) acima de 5 mg\/dL. Entretanto, quando h\u00e1 um aumento na destrui\u00e7\u00e3o das hem\u00e1cias e as fun\u00e7\u00f5es hep\u00e1ticas est\u00e3o reduzidas ocorre a Hiperbilirrubinemia, intensificando a colora\u00e7\u00e3o amarelada da pele do rec\u00e9m-nascido (RN).<strong><sup>(1, 2, 3) <\/sup><\/strong><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-54d8ce2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"54d8ce2\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-d85c27a\" data-id=\"d85c27a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bbf2057 elementor-widget elementor-widget-text-editor\" data-id=\"bbf2057\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 Trata-se de um problema cl\u00ednico mundial, que afeta cerca de 481.000 rec\u00e9m-nascidos (RN) a cada ano, onde 114.000 morrem e por volta de 63.000 sobrevivem com sequelas moderadas ou graves.<strong><sup>(1) <\/sup><\/strong>Nos \u00faltimos 10 anos, no Brasil, ocorreram cerca de 1.008 \u00f3bitos por icter\u00edcia neonatal. A Hiperbilirrubinemia por concentra\u00e7\u00f5es elevadas de Bb indireta (BI) desencadeia um processo patol\u00f3gico lesivo ao c\u00e9rebro, a encefalopatia bilirrub\u00ednica. A forma cr\u00f4nica dessa doen\u00e7a se chama Kernicterus; nela, os RN desenvolvem sequelas cl\u00ednicas permanentes devido \u00e0 toxicidade da bilirrubina. O diagn\u00f3stico m\u00e9dico da Hiperbilirrubinemia considera a idade p\u00f3s-natal, a etiologia e os n\u00edveis s\u00e9ricos de BT para indicar o tipo de tratamento. Por conceito recente, a Hiperbilirrubinemia foi definida como \u201csignificante\u201d quando a BT atinge valores \u226512 mg\/dL; como \u201cgrave ou severa\u201d se a BT for \u226520 mg\/dL ou quando h\u00e1 ind\u00edcios de encefalopatia bilirrub\u00ednica aguda em qualquer n\u00edvel de BT; finalmente, como \u201cextrema\u201d quando a BT for \u226525 mg\/dL e quando h\u00e1 evid\u00eancias de encefalopatia bilirrub\u00ednica em fase inicial ou intermedi\u00e1ria em qualquer n\u00edvel de BT. A Figura 2 remete \u00e0 identifica\u00e7\u00e3o da icter\u00edcia intensa, de cor alaranjada, na pele e esclera, e os dep\u00f3sitos de Bb no tecido cerebral, Kernicterus.<strong><sup>(2, 3, 4) <\/sup><\/strong><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-e80875d\" data-id=\"e80875d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8de4dd5 elementor-widget elementor-widget-image\" data-id=\"8de4dd5\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"501\" height=\"325\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-2.png\" class=\"attachment-large size-large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-2.png 501w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-2-300x195.png 300w\" sizes=\"(max-width: 501px) 100vw, 501px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-1a4e10e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1a4e10e\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-15affa9\" data-id=\"15affa9\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-dc672ef elementor-widget elementor-widget-text-editor\" data-id=\"dc672ef\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>Os fatores de risco epidemiol\u00f3gicos e cl\u00ednico laboratoriais para icter\u00edcia em RN com IG \u2265 35 sem. e o fatores de risco para neurotoxicidade bilirrub\u00ednica em prematuros apontados pela Sociedade Brasileira de Pediatria (SBP) est\u00e3o descritos na Figura 3<sup>.<strong>(2)<\/strong><\/sup><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-88ee6d0 elementor-widget elementor-widget-image\" data-id=\"88ee6d0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"960\" height=\"638\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem11-1.jpg\" class=\"attachment-large size-large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem11-1.jpg 960w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem11-1-300x199.jpg 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem11-1-768x510.jpg 768w\" sizes=\"(max-width: 960px) 100vw, 960px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-425da2e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"425da2e\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0722ef4\" data-id=\"0722ef4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b8a882 elementor-widget elementor-widget-text-editor\" data-id=\"8b8a882\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 A icter\u00edcia por Hiperbilirrubinemia indireta (BI) tem progress\u00e3o c\u00e9falo-caudal e pode ser avaliada por digitopress\u00e3o sobre \u00e1reas determinadas da pele, sob luz natural, as chamadas Zonas de Kramer.<strong><sup>(2, 5)<\/sup><\/strong> O m\u00e9todo de Kramer para o diagn\u00f3stico de icter\u00edcia alcan\u00e7ou 76,1% de precis\u00e3o e uma concord\u00e2ncia moderada com a avalia\u00e7\u00e3o transcut\u00e2nea na avalia\u00e7\u00e3o de RN com ascend\u00eancia negra.<strong><sup>(6)<\/sup><\/strong> A identifica\u00e7\u00e3o visual da icter\u00edcia \u00e9 mais confi\u00e1vel se avaliada por um profissional experiente, examinando o RN sob ilumina\u00e7\u00e3o natural, antes do in\u00edcio da fototerapia; uma vez que, a luz artificial em excesso, pouca ilumina\u00e7\u00e3o e a exposi\u00e7\u00e3o \u00e0 fototerapia comprometem o seguimento cl\u00ednico do tratamento.<strong><sup>(2, 5, 6, 7)<\/sup><\/strong> A Figura 4 apresenta a correla\u00e7\u00e3o entre as zonas de Kramer na avalia\u00e7\u00e3o visual e os n\u00edveis s\u00e9ricos de BT; a Figura 5 mostra as zonas de risco na avalia\u00e7\u00e3o dos n\u00edveis de BT s\u00e9rica.<strong><sup>(7)<\/sup><\/strong><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-inner-section elementor-element elementor-element-59ed16e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"59ed16e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-4b34d9f\" data-id=\"4b34d9f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d1da14c elementor-widget elementor-widget-image\" data-id=\"d1da14c\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"932\" height=\"493\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem12-1.jpg\" class=\"attachment-large size-large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem12-1.jpg 932w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem12-1-300x159.jpg 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem12-1-768x406.jpg 768w\" sizes=\"(max-width: 932px) 100vw, 932px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-8b99699\" data-id=\"8b99699\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3110d97 elementor-widget elementor-widget-image\" data-id=\"3110d97\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"1043\" height=\"720\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-1043x720.png\" class=\"attachment-large size-large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-1043x720.png 1043w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-300x207.png 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-768x530.png 768w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-1536x1061.png 1536w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-2048x1414.png 2048w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-1024x707.png 1024w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13-1564x1080.png 1564w\" sizes=\"(max-width: 1043px) 100vw, 1043px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-64869bf elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"64869bf\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-59f2b02\" data-id=\"59f2b02\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b8d7e4a elementor-widget elementor-widget-text-editor\" data-id=\"b8d7e4a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 Destaca-se a pouca concord\u00e2ncia na avalia\u00e7\u00e3o cl\u00ednica da icter\u00edcia, tanto por enfermeiros quanto por m\u00e9dicos. A estimativa cl\u00ednica em RN com n\u00edveis de BT &gt;12mg\/dL mostra-se insuficiente e requer dosagem s\u00e9rica da BT ou avalia\u00e7\u00e3o transcut\u00e2nea com um bilirrubin\u00f4metro, como demonstrado nas Figuras 6.<strong><sup>(2, 3)<\/sup> <\/strong><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4b7d1a2\" data-id=\"4b7d1a2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0b85af8 elementor-widget elementor-widget-image\" data-id=\"0b85af8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"827\" height=\"335\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-6.png\" class=\"attachment-2048x2048 size-2048x2048\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-6.png 827w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-6-300x122.png 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/figura-6-768x311.png 768w\" sizes=\"(max-width: 827px) 100vw, 827px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-5ca4282 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5ca4282\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-fda9a1c\" data-id=\"fda9a1c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8884a79 elementor-widget elementor-widget-text-editor\" data-id=\"8884a79\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p class=\"MsoNormal\" style=\"text-align:justify;text-indent:1.0cm;line-height:\n130%\"><span style=\"mso-bidi-font-size:12.0pt;line-height:130%\">A fototerapia, Figura\n7, \u00e9 o tratamento mais eficaz para a icter\u00edcia neonatal e consiste em um\nequipamento emissor de luz com irradi\u00e2ncia espectral terap\u00eautica padr\u00e3o de 8 a\n10 \u03bcW\/cm<sup>2<\/sup>\/nm (microwatts \/ cent\u00edmetro quadrado \/ man\u00f4metro) ou\nintensiva de 30 \u03bcW\/cm<sup>2<\/sup>\/nm que entra na superf\u00edcie da pele e\ntransforma a bilirrubina n\u00e3o conjugada presente no sangue em um produto\nhidrossol\u00favel para poder ser excretado. A partir da observa\u00e7\u00e3o cl\u00ednica de uma\nenfermeira inglesa, Sister Jean Ward em 1956, da cria\u00e7\u00e3o da fototerapia baseada\nem luz artificial por Cremer e colegas e da descoberta das altera\u00e7\u00f5es f\u00edsicas e\nqu\u00edmicas por Mc. Donagh e Lighter em 1985, v\u00e1rios modelos novos e mais eficazes\nforam inseridos no mercado.<sup>(<b>2, 8<\/b>)<\/sup>\n<span style=\"background:yellow;mso-highlight:yellow\"><o:p><\/o:p><\/span><\/span><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6d5b451 elementor-widget elementor-widget-image\" data-id=\"6d5b451\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"768\" height=\"535\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-768x535.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-768x535.png 768w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-300x209.png 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-1043x727.png 1043w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-1536x1070.png 1536w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-2048x1427.png 2048w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-1024x714.png 1024w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem17-1550x1080.png 1550w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-2238604\" data-id=\"2238604\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d46ae0e elementor-widget elementor-widget-image\" data-id=\"d46ae0e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"616\" height=\"1043\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-616x1043.png\" class=\"attachment-large size-large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-616x1043.png 616w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-177x300.png 177w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-768x1301.png 768w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-907x1536.png 907w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1-638x1080.png 638w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem15-1.png 1000w\" sizes=\"(max-width: 616px) 100vw, 616px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-f4c4eea elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f4c4eea\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-24f89d1\" data-id=\"24f89d1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-93c02eb elementor-widget elementor-widget-text-editor\" data-id=\"93c02eb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 Durante a fototerapia, a emiss\u00e3o de raios no comprimento de onda da luz azul tem como fun\u00e7\u00e3o diminuir os n\u00edveis plasm\u00e1ticos de Bb e requer a exposi\u00e7\u00e3o do RN despido com o uso de prote\u00e7\u00e3o ocular e de fraldas para prote\u00e7\u00e3o das g\u00f4nadas. A bilirrubina absorve a luz emitida pelo aparelho, onde na faixa de 400 a 500 nm penetrar\u00e1 na epiderme e atingir\u00e1 o tecido subcut\u00e2neo; sendo assim, apenas a Bb que circula pr\u00f3ximo \u00e0 superf\u00edcie da pele (at\u00e9 2 mm) ser\u00e1 atingida diretamente.<strong><sup>(2, 8, 9) <\/sup><\/strong>O resultado da fototerapia ser\u00e1 a transforma\u00e7\u00e3o fotoqu\u00edmica da Bb nas \u00e1reas que foram expostas \u00e0 luz, alterando a estrutura da mol\u00e9cula de Bb e permitindo que ela seja eliminada pelos rins ou pelo f\u00edgado sem a ocorr\u00eancia\u00a0 de modifica\u00e7\u00f5es metab\u00f3licas.<strong><sup>(8)<\/sup><\/strong><\/p><p>\u00a0 \u00a0 \u00a0 \u00a0 Os crit\u00e9rios de indica\u00e7\u00e3o da fototerapia ainda n\u00e3o tem consenso e seu embasamento se d\u00e1 por \u201cevid\u00eancias limitadas\u201d; tomando como par\u00e2metros a\u201d dosagem peri\u00f3dica da Bb total (BT), a idade gestacional e a idade p\u00f3s-natal\u201d.<sup>(<strong>2<\/strong>)<\/sup><\/p><p class=\"MsoNormal\" style=\"text-align: justify; text-indent: 1.0cm; line-height: 130%;\"><span style=\"mso-bidi-font-size: 12.0pt; line-height: 130%;\">\u00a0<\/span><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-f3e0359 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f3e0359\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0ec956b\" data-id=\"0ec956b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-inner-section elementor-element elementor-element-0da58be elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0da58be\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-4fa7c49\" data-id=\"4fa7c49\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-636f824 elementor-widget elementor-widget-text-editor\" data-id=\"636f824\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>O enfermeiro pode instituir um plano de cuidados ao RN em fototerapia a partir das recomenda\u00e7\u00f5es descritas abaixo:<\/p><ul><li>Conhecer as diretrizes fornecidas pelos fabricantes para se familiarizar com os equipamentos envolvidos na fototerapia.<\/li><li>Posicionar o aparelho de fototerapia \u00e0, no m\u00e1ximo, 30 a 30,5 cm do RN. Na fototerapia com LED, o aparelho pode ser mantido a uma dist\u00e2ncia de at\u00e9 15 cm do RN. Considerando a superf\u00edcie mais elevada do RN.<\/li><li>Colocar prote\u00e7\u00e3o ocular e fraldas durante a fototerapia. N\u00edveis muito elevados de Bb, contudo, indicam a remo\u00e7\u00e3o da fralda. Coletores de urina podem provocar les\u00f5es de pele. No nosso meio coloca-se uma fralda pesada seca aberta sob o per\u00edneo do RN para a pesagem diferencial da diurese.<\/li><li>Remover a prote\u00e7\u00e3o ocular a cada 4 ou 6h para a promover a intera\u00e7\u00e3o m\u00e3e &amp; RN. Estimular os cuidados maternos na higieniza\u00e7\u00e3o e alimenta\u00e7\u00e3o do filho.<\/li><li>Observar a integridade da prote\u00e7\u00e3o ocular, avaliar a presen\u00e7a de sinais sugestivos de les\u00e3o ou de infec\u00e7\u00e3o; prescrever cuidados de enfermagem e documentar altera\u00e7\u00f5es e condutas.<\/li><li>Garantir a oferta di\u00e1ria de l\u00edquidos para a idade gestacional e p\u00f3s-natal. Avaliar as perdas h\u00eddricas, a hidrata\u00e7\u00e3o cutaneomucosa, calcular o balan\u00e7o h\u00eddrico.<\/li><li>Manter a amamenta\u00e7\u00e3o. Negociar a redu\u00e7\u00e3o do tempo de mamada com a m\u00e3e se n\u00edveis elevados de Bb indicarem aumento da exposi\u00e7\u00e3o \u00e0s luzes. Estimular a m\u00e3e a esgotar as mamas para que ela mesma ofere\u00e7a seu leite ao filho.<\/li><li>Monitorar os sinais vitais pelo menos a cada 4 h. Incubadora ou ber\u00e7o de calor radiante podem ser necess\u00e1rios para garantir a estabilidade t\u00e9rmica do RN e maximizar a exposi\u00e7\u00e3o da pele \u00e0 luz.<\/li><li>Cobrir equipos para infus\u00e3o lip\u00eddica com material resistente \u00e0 luz para evitar a peroxida\u00e7\u00e3o lip\u00eddica.<\/li><li>Desligar o aparelho de fototerapia durante a coleta de sangue para n\u00edveis de Bb; tanto a Bb conjugada quanto a n\u00e3o conjugada sofrem foto-oxida\u00e7\u00e3o e o resultado ficar\u00e1 comprometido.<\/li><li>Observar aumento da icter\u00edcia e efeitos colaterais da fototerapia, integridade da pele comprometida, instabilidade t\u00e9rmica, alimenta\u00e7\u00e3o deficiente, sinais de desidrata\u00e7\u00e3o, diurese reduzida, elimina\u00e7\u00f5es fecais diminu\u00eddas, letargia, desconforto, potenciais sinais de encefalopatia bilirrub\u00ednica.<\/li><li>Avaliar o n\u00edvel de Bb transcut\u00e2nea e a irradi\u00e2ncia luminosa periodicamente. Verificar a irradi\u00e2ncia com um radi\u00f4metro (Figura 8), antes de iniciar a fototerapia e pelo menos uma vez ao dia. O comprimento de onda luminosa monitorado corresponde ao espectro da luz azul vis\u00edvel, de 400 at\u00e9 550 nm. Uma irradi\u00e2ncia inferior a 8 \u03bcW\/cm2\/nm indica que as l\u00e2mpadas precisam ser trocadas. As medidas de irradi\u00e2ncia s\u00e3o realizadas em cinco pontos de um ret\u00e2ngulo imagin\u00e1rio de 30 cm por 60 cm envolvendo a crian\u00e7a, nas quatro pontas, superiores e inferiores, e em um ponto central. Anotadas as medidas, o valor final corresponde \u00e0 m\u00e9dia dos cinco pontos (Figura 9).<sup>(<strong>2, 3, 9<\/strong>)<\/sup><\/li><\/ul>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-50a4793 elementor-widget elementor-widget-image\" data-id=\"50a4793\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"768\" height=\"513\" src=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-768x513.png\" class=\"attachment-medium_large size-medium_large\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-768x513.png 768w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-300x200.png 300w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-1043x697.png 1043w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-1536x1026.png 1536w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-2048x1368.png 2048w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-1024x684.png 1024w, https:\/\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem16-1-1617x1080.png 1617w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3ddbde4 elementor-widget elementor-widget-text-editor\" data-id=\"3ddbde4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0A partir do exposto sabe-se que a Hiperbilirrubinemia indireta neonatal \u00e9 uma patologia frequente em RN, secund\u00e1ria a produ\u00e7\u00e3o de BI por hem\u00f3lise dos eritr\u00f3citos e associada \u00e0 imaturidade do f\u00edgado na sua excre\u00e7\u00e3o.\u00a0 Este problema \u00e9 intensificado em beb\u00eas prematuros, especialmente naqueles com de IG &lt;35 sem. Entretanto, preocupa o fato de a Bb em n\u00edveis muito elevados se depositar no tecido cerebral e acarretar danos irrevers\u00edveis. Existem dois tipos de icter\u00edcia, a fisiol\u00f3gica e a patol\u00f3gica; para ambas, \u00e9 necess\u00e1rio o olhar cl\u00ednico apurado do enfermeiro(a) para estabelecer o diagn\u00f3stico de enfermagem r\u00e1pido e eficaz.\u00a0 Isto \u00e9, identificar os fatores de risco, avaliar a colora\u00e7\u00e3o da pele e mucosas ao longo da adapta\u00e7\u00e3o ao nascimento e tamb\u00e9m a confirma\u00e7\u00e3o atrav\u00e9s dos par\u00e2metros de BB fornecidos pelo bilirrubin\u00f4metro transcut\u00e2neo.<\/p><p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0Comprovado o diagn\u00f3stico m\u00e9dico, inicia-se o principal tratamento, a fototerapia. Esta consiste na aplica\u00e7\u00e3o de luz que fotoisomeriza e degrada a Bb presente na circula\u00e7\u00e3o perif\u00e9rica. O desfecho depende da quantidade de luz irradiada sobre a superf\u00edcie cut\u00e2nea e da resposta do RN ao tratamento.<\/p><p>\u00a0 \u00a0 \u00a0 \u00a0<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-8555591 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8555591\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3c467a8\" data-id=\"3c467a8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-84ee7e4 elementor-widget elementor-widget-text-editor\" data-id=\"84ee7e4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>\u00a0 \u00a0 \u00a0Ademais, conclui-se que a avalia\u00e7\u00e3o cl\u00ednica e sistem\u00e1tica do neonato, pelo enfermeiro, \u00e9 fundamental para a identifica\u00e7\u00e3o precoce da icter\u00edcia, estabelecimento do tratamento e preven\u00e7\u00e3o de agravos irrevers\u00edveis.<\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-adc9f31 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"adc9f31\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5661c7f\" data-id=\"5661c7f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-25723fb elementor-widget elementor-widget-text-editor\" data-id=\"25723fb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p><strong>Refer\u00eancias<\/strong><\/p><ol><li>Godoy W, Mesquita KS, Gon\u00e7alves M. Preval\u00eancia de icter\u00edcia neonatal em um servi\u00e7o de m\u00e9dia complexidade na cidade de Macei\u00f3\/AL. SEMPESq &#8211; Semana de Pesquisa da Unit. Alagoas; 2021 [cited 2022 Nov 28]. 1-4 p. v. 9. Available:<a href=\"https:\/\/eventos.set.edu.br\/al_sempesq\/article\/view\/15170\/6803\">https:\/\/eventos.set.edu.br\/alsempesq\/article\/view\/15170\/6803<\/a><\/li><li>Sociedade Brasileira de Pediatria. Departamento Cient\u00edfico de Neonatologia. Manual de Orienta\u00e7\u00e3o. Hiperbilirrubinemia indireta no per\u00edodo neonatal. 2021. Available: <a href=\"https:\/\/www.sbp.com.br\/fileadmin\/user_upload\/23176c-MO_Hiperbilirrubinemia_indireta_periodo_neo.pdf\">https:\/\/www.sbp.com.br\/fileadmin\/user_upload\/23176c-MO_Hiperbilirrubinemia_indireta_periodo_neo.pdf<\/a><\/li><li>Minist\u00e9rio da Sa\u00fade. Secretaria de Aten\u00e7\u00e3o \u00e0 Sa\u00fade. Departamento de A\u00e7\u00f5es Program\u00e1ticas Estrat\u00e9gicas. 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Available: <a href=\"https:\/\/rsdjournal.org\/index.php\/rsd\/article\/view\/6423\/6026\">https:\/\/rsdjournal.org\/index.php\/rsd\/article\/view\/6423\/6026<\/a><\/li><li>Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review Article. Iran J Public Health. 2016 May;45(5):558-68)<\/li><li>Dionis I, Chillo O, Bwire GM, Ulomi C, Kilonzi M, Balandya E. Reliability of visual assessment of neonatal jaundice among neonates of black descent: a cross-sectional study from Tanzania. BMC Pediatr. 2021 Sep 3;21(1):383. doi: 10.1186\/s12887-021-02859-x<\/li><li>Jain N. Sachan R. Vaenkatagiri P. Neonatal jaundice. In: Indian Academy of Pediatrics. Standard treatment guidelines. 2022. Available: <a href=\"https:\/\/iapindia.org\/pdf\/Ch-079-Neonatal-Jaundice.pdf\">https:\/\/iapindia.org\/pdf\/Ch-079-Neonatal-Jaundice.pdf<\/a><\/li><li>Maisels MJ. Sister Jean Ward, phototherapy, and jaundice: a unique human and photochemical interaction. Journal of Perinatology. 2015 35, 671\u2013675<\/li><li>Silva A, Palumbo IC, Almada C. Conhecimentos da equipe de enfermagem sobre fototerapia no setor de alojamento conjunto de um Hospital Escola da Zona Norte de SP. J Health Sci Inst [Internet]. 2019 [cited 2022 Nov 28];37(3):213-217. Available: <a href=\"https:\/\/repositorio.unip.br\/wp-content\/uploads\/2020\/12\/04V37_n3_2019_p213a217.pdf\">https:\/\/repositorio.unip.br\/wp-content\/uploads\/2020\/12\/04V37_n3_2019_p213a217.pdf<\/a><\/li><li>Stewart M. Phototherapy for neonatal jaundice. The Royal Children&#8217;s Hospital Melbourne. Clinical Guidelines (Nursing). Nursing Clinical Effectiveness Committee. Available: https:\/\/www.rch.org.au\/rchcpg\/hospital_clinical_guideline_index\/Phototherapy_for_neonatal_jaundice\/<\/li><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c7fcf12 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c7fcf12\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8d1ef31\" data-id=\"8d1ef31\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-951ef5b elementor-widget elementor-widget-text-editor\" data-id=\"951ef5b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-text-editor elementor-clearfix\">\n\t\t\t\t\t<p>COMO CITAR:<\/p><p>CAMPOS, A.J.M; BORDA, A.S; DEORRIST, C.C; LAGUE, G.K.L; LOPES, K.M; PALSKUSKI, K.L; BARELA, L.L; OTAVIANI, L.V; KARL, I.D.S; MENDES, E.W.\u00a0 <strong>Hiperbilirrubinemia e fototerapia: t\u00f3picos para o cuidado do rec\u00e9m-nascido.<\/strong> Blog LEVi@enf2022(viewed Dezembro 2022) Avaliable from: <a href=\"https:\/\/www.ufrgs.br\/levi\/hiperbilirrubinemia\/\">https:\/\/www.ufrgs.br\/levi\/hiperbilirrubinemia\/<\/a><\/p>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Publicado em 16 de dezembro de 2022. \u00a0 \u00a0 \u00a0 \u00a0 A icter\u00edcia neonatal caracteriza-se pela eleva\u00e7\u00e3o da concentra\u00e7\u00e3o de bilirrubina (Bb) no sangue (Hiperbilirrubinemia), tornando a colora\u00e7\u00e3o da pele amarelada. A Hiperbilirrubinemia costuma ser classificada como \u201cindireta\u201d ou \u201cdireta\u201d em fun\u00e7\u00e3o do tipo de bilirrubina que desencadeia a altera\u00e7\u00e3o; isso \u00e9, por excesso de&hellip; <br \/> <a class=\"button small blue\" href=\"https:\/\/www.ufrgs.br\/levi\/hiperbilirrubinemia\/\">Leia mais<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"closed","template":"elementor_header_footer","meta":{"spay_email":""},"jetpack-related-posts":[{"id":13964,"url":"https:\/\/www.ufrgs.br\/levi\/publicacoes-2022\/","url_meta":{"origin":15712,"position":0},"title":"Publica\u00e7\u00f5es 2022","date":"18 de outubro de 2022","format":false,"excerpt":"A import\u00e2ncia do Letramento em Sa\u00fade para o cuidado da CRIANESAutoras: Enf\u00aa Esp. Su\u00e9len Heningues Leiman, Prof\u00aa Dr\u00aa Alessandra Vaccari. Data da publica\u00e7\u00e3o 17 de dezembro de 2022 A brincadeira como estrat\u00e9gia de promo\u00e7\u00e3o do desenvolvimento infantilAutoras: Acad. Enf. Agatha Caroline Valanera Teixeira, Acad. Enf. Alessandra Porto D'\u00e1vila, Acad. Enf.\u2026","rel":"","context":"Post similar","img":{"alt_text":"","src":"https:\/\/i2.wp.com\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/10\/Banner-2022-2240-\u00c3\u0097-300-px.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":15592,"url":"https:\/\/www.ufrgs.br\/levi\/roda-de-conversa\/","url_meta":{"origin":15712,"position":1},"title":"Roda de conversa","date":"16 de dezembro de 2022","format":false,"excerpt":"Publicado em 16 de dezembro de 2022. \u00a0 \u00a0 \u00a0 \u00a0As rodas de conversa com as fam\u00edlias dos rec\u00e9m-nascidos prematuros tem como objetivo:\u00a0 \u00a0 Promover o cuidado com o crescimento e o desenvolvimento de rec\u00e9m-nascido pr\u00e9-termo, incentivando a inclus\u00e3o dos pais e da fam\u00edlia no cuidado aos beb\u00eas mais vulner\u00e1veis\u2026","rel":"","context":"Post similar","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Imagem13.jpg?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":14841,"url":"https:\/\/www.ufrgs.br\/levi\/policiais-civis\/","url_meta":{"origin":15712,"position":2},"title":"Policiais Civis","date":"22 de novembro de 2022","format":false,"excerpt":"Publicado em 22 de novembro de 2022.\u00a0 \u00a0 \u00a0 \u00a0 O trabalho da pol\u00edcia geral est\u00e1 associado a diversos riscos e perigos, que tem potencial de prejudicar a sa\u00fade f\u00edsica e mental desses trabalhadores\u00b9. 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A Liga Acad\u00eamica de Enfermagem (LAEnf), projeto de\u2026","rel":"","context":"Post similar","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/www.ufrgs.br\/levi\/wp-content\/uploads\/2022\/12\/Banner-2022-29-1-1920x476.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":15678,"url":"https:\/\/www.ufrgs.br\/levi\/letramento\/","url_meta":{"origin":15712,"position":4},"title":"LETRAMENTO","date":"16 de dezembro de 2022","format":false,"excerpt":"Publicado em 16 de dezembro de 2022. As crian\u00e7as com necessidades especiais em sa\u00fade (CRIANES) demandam cuidados especializados e acessam servi\u00e7os de sa\u00fade diversas vezes ao longo dos anos. 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