Major Risk factors: - Stony Brook School of Medicine
Major Risk factors:
• Predischarge Bilirubin level in the high-risk zone on the bilirubin chart
• Blood group incompatibility with positive direct antiglobulin test
• Hemolytic disease (G6PD, spherocytosis… )
• Gestational age 35–36 wk
• Previous sibling received phototherapy
• Cephalohematoma or significant bruising
• Exclusive breastfeeding (particularly if nursing is not going well and weight loss is excessive)
• East Asian race
Minor risk factors:
• Macrosomia
• Infant of a Diabetic mother
• Maternal age [pic]25 y
• Male gender
• Pre-discharge TSB or TcB level in the high intermediate-risk zone
• Gestational age 37–38 wk
• Jaundice observed before discharge
• Previous sibling with jaundice
For any newborn who is jaundiced at less then 24 hours of age obtain:
• Serum Bilirubin Level (total and direct)
• Maternal Blood Type (look for isoimmune antibodies, Rh incompatibility)
• Infants Cord Blood Type (look at Rh and look for DAT +)
• CBC with manual differential
• Reticulocyte count
**Determination of the rate of rise of TSB and the infant's age may help determine how often to monitor bilirubin levels and whether to begin photo-therapy.
**Continued observation may be an appropriate alternative to repeated TSB testing and phototherapy.
Phototherapy
• Minimum evaluation and documentation must include the infant’s age, maternal history, physical exam, total serum bilirubin and the rate of rise.
• Phototherapy should produce a decline in the total bilirubin level of 1 to 2 mg/dL within 4 to 6 hours, and the decline should continue thereafter. I
Exchange Transfusion
The goal is to prevent kernicterus.
• If the total bilirubin level does not decline despite appropriate phototherapy, or is at or above a high level of risk on the phototherapy graph, exchange transfusion is recommended.
• Intensive phototherapy is recommended while preparations are being made for exchange transfusion.
o This will hopefully prevent further elevation of the bilirubin level.
o If level then drops below exchange transfusion levels during preparation, the transfusion may be avoided.
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• Failure of intensive phototherapy to lower the total bilirubin level strongly suggests the presence of hemolytic disease or some other pathologic process and warrants further investigation.
Phototherapy Guidelines for infants >35weeks gestation from
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Additional References:
|Jaundice in a newborn: Answers to questions about a common clinical problem. First of two parts. |
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Jaundice in a newborn: How to head off an urgent situation. Second of two parts.
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|Treating acute bilirubin encephalopathy--before it's too late |
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