Materiały źródłowe

• #1 Newborn jaundice: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001559.htm

  Newborn jaundice occurs when a baby has a high level of bilirubin in the blood. Bilirubin is a yellow substance that the body creates when it replaces old red blood cells. The liver helps break down the substance so it can be removed from the body in the stool. […] A high level of bilirubin makes a baby’s skin and whites of the eyes look yellow. This is called jaundice. […] Most newborns have some jaundice. This is called physiological jaundice. It is usually noticeable when the baby is 2 to 4 days old. Most of the time, it does not cause problems and goes away within 2 weeks. […] Babies who are born too early (premature) are more likely to develop jaundice than full-term babies. […] Jaundice causes a yellow color of the skin. It usually begins on the face and then moves down to the chest, belly area, legs, and soles of the feet.

• #2 Infant jaundice – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865

  Infant jaundice is yellow discoloration of a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells. […] Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice. […] Most infants born between 35 weeks’ gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

• #3

  https://www.nhs.uk/conditions/jaundice-newborn/treatment/

  Speak to your midwife, health visitor or GP if your baby develops jaundice. They’ll be able to assess whether treatment is needed. […] Treatment is usually only needed if your baby has high levels of a substance called bilirubin in their blood, so tests need to be carried out to check this. […] Most babies with jaundice do not need treatment because the level of bilirubin in their blood is found to be low. […] If treatment is not needed, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. […] If your baby’s jaundice does not improve over time, or tests show high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion. […] These treatments are recommended to reduce the risk of a rare but serious complication of newborn jaundice called kernicterus, which can cause brain damage.

• #4 Neonatal jaundice – MedCrave online

  https://medcraveonline.com/NCOAJ/neonatal-jaundice.html

  yellow discoloration of the skin and the mucosa is caused by accumulation of excess of bilirubin in the tissue and plasma (serum bilirubin level should be in excess 7mg/dl. 30-50% of term newborn and more of preterm newborns develop clinical jaundice.1 […] The goal of treatment of physiologic jaundice is to prevent the level of serum bilirubin from rising. Two type of therapy can be used for infants with physiologic jaundice; phototherapy and exchange transfusion. […] the main form of therapy for infants with physiologic jaundice is phototherapy, the use of intense fluorescent light on the infant exposed skin it is belived that this light in the blue range acts to decompose bilirubin by the process of photo oxidation, phototherapy is effective in preventing or reducing an increase in bilirubin levels.

• #5 Jaundice in Newborns (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/jaundice.html

  Babies with jaundice have a yellow coloring of the skin and eyes. This happens when there is too much bilirubin in the baby’s blood. […] A newborn baby’s liver does not remove bilirubin as well as an adult’s does. Jaundice happens when bilirubin builds up faster than the liver can break it down and pass it from the body. […] Most types of jaundice go away on their own. Others need treatment to lower bilirubin levels. […] A baby with jaundice has skin that looks yellow. It starts on the face, then the chest and stomach, and then the legs. The whites of a baby’s eyes also look yellow. […] Call the doctor if your baby: starts to look or act sick, is not feeding well, is sleepier than usual, has jaundice that gets worse. […] Treatment depends on the cause of the jaundice, the bilirubin levels, and a baby’s age.

• #6 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Jaundice Nursing Care Plans and Nursing Diagnosis […] Hyperbilirubinemia is the elevation of serum bilirubin levels that is related to the hemolysis of RBCs and subsequent reabsorption of unconjugated bilirubin from the small intestines. The condition may be benign or place the neonate at risk for multiple complications/untoward effects. […] The newborns liver is immature, which contributes to icterus, or jaundice. The liver cannot clear the blood of bile pigments that result from the normal postnatal destruction of red blood cells. The higher the blood bilirubin level is, the deeper jaundice and the greater risk for neurological damage. Physiological jaundice is normal, while pathological jaundice is more serious, which occurs within 24 hours of birth, and is secondary to an abnormal condition, such ABO-Rh incompatibility. The normal rise in bilirubin levels in preterm infants is slower than in full-term infants. It lasts longer, which predisposes the infant to hyperbilirubinemia or excessive bilirubin levels in the blood. […] Physiological jaundice is the most common type of newborn hyperbilirubinemia. This unconjugated hyperbilirubinemia presents in newborns after 24 hours of life and can last up to the first week. Pathological jaundice is defined as the appearance of jaundice in the first 24 hours of life due to an increase in serum bilirubin levels greater than 5 mg/dl/day, conjugated bilirubin levels 20% of total serum bilirubin, peak levels higher than the normal range, and the presence of clinical jaundice greater than two weeks. Breast milk jaundice occurs in breastfed newborns between the first and third day of life but peaks by day 5 to 15, with a decline occurring by the third week of life (Morrison, 2021).

• #7 Jaundice in babies | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/jaundice-in-babies

  Jaundice shows up in babies as a yellowish tinge to the skin and eyes. […] Jaundice is very common in newborn babies about six out of 10 newborns have jaundice to varying degrees. […] Jaundice is caused by an excess of a chemical called bilirubin. […] Most jaundice is physiological jaundice. […] Physiological jaundice will resolve by itself once the baby’s liver is functioning at full speed. […] In babies where jaundice levels are very high in the days after birth, treatment using blue lights (phototherapy) may be required. […] Newborn babies are often affected by jaundice, which makes their skin and eyes have a yellowish tinge. […] Jaundice usually appears on the second or third day. […] If your baby is full-term and healthy, mild jaundice is nothing to worry about and will resolve by itself within a week or so.

• #8 Patient education: Jaundice in newborn infants (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics/print

  Patient education: Jaundice in newborn infants (Beyond the Basics) […] Jaundice is the medical term for a yellow-tinged coloring of the skin or mucous membranes (such as the thin inner lining of the eyes and mouth). The yellow color is caused by a natural pigment called bilirubin, which is a waste product that the body creates when it breaks down old red blood cells. It is normal for all babies to have an increase in their blood bilirubin levels during the first three to five days after birth. When bilirubin builds up in the skin and blood to levels that are higher than normal, babies develop jaundice. […] If not treated, high bilirubin levels can lead to serious problems, including brain damage. For this reason, all babies should be checked for jaundice soon after birth. […] Fortunately, safe and effective treatments are available to prevent more serious conditions.

• #9 Jaundice in Newborns (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/jaundice.html

  Babies with jaundice have a yellow coloring of the skin and eyes. This happens when there is too much bilirubin in the baby’s blood. […] A newborn baby’s liver does not remove bilirubin as well as an adult’s does. Jaundice happens when bilirubin builds up faster than the liver can break it down and pass it from the body. […] Most types of jaundice go away on their own. Others need treatment to lower bilirubin levels. […] A baby with jaundice has skin that looks yellow. It starts on the face, then the chest and stomach, and then the legs. The whites of a baby’s eyes also look yellow. […] Call the doctor if your baby: starts to look or act sick, is not feeding well, is sleepier than usual, has jaundice that gets worse. […] Treatment depends on the cause of the jaundice, the bilirubin levels, and a baby’s age.

• #10 Newborn Jaundice Assessment | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/newborn-jaundice.html

  Newborn jaundice is a common condition that affects many babies shortly after birth. Jaundice in newborns is characterized by a yellowing of the skin and eyes due to high levels of bilirubin in the blood. It is normal for bilirubin levels to increase after birth, typically peaking around the third to fifth day. While it is common for newborns to have a mild increase in bilirubin after birth, it’s important to monitor the levels to ensure they don’t reach harmful levels. […] When examining a baby for jaundice, several key signs and methods are used: […] The first step in assessing jaundice is observing the baby’s skin tone. A yellow tint on the baby’s forehead, under the eyes, on the nose, and chin can indicate jaundice. […] Pressing a finger on the baby’s skin (forehead, nose, chin, sternum, elbows, wrists, knees, ankles) and observing the return of color can help identify the presence of jaundice. […] Jaundice typically follows a cephalocaudal progression, meaning it starts from the head and progresses downward. Monitoring this progression is crucial for understanding the severity of the condition. […] Checking the nail beds and the whites of the eyes (sclera) for yellowing can help determine if jaundice is severe. Severe jaundice will affect these areas.

• #11 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  Offer parents or carers information about neonatal jaundice that is tailored to their needs and expressed concerns. This information should be provided through verbal discussion backed up by written information. Care should be taken to avoid causing unnecessary anxiety to parents or carers. Information should include: […] Ensure that adequate support is offered to all women who intend to breastfeed exclusively. For information on breastfeeding support, see NICE’s guideline on postnatal care. […] In all babies: check whether there are factors associated with an increased likelihood of developing significant hyperbilirubinaemia soon after birth […] examine the baby for jaundice at every opportunity especially in the first 72 hours. […] Parents, carers and healthcare professionals should all look for jaundice (visual inspection) in babies.

• #12 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  When looking for jaundice (visual inspection): check the naked baby in bright and preferably natural light […] examine the sclerae and gums, and press lightly on the skin to check for signs of jaundice in 'blanched’ skin […] be aware that changes to skin pigmentation because of hyperbilirubinaemia may be harder to see in darker skin. […] Do not rely on visual inspection alone to estimate the bilirubin level in a baby with suspected jaundice. […] Do not measure bilirubin levels routinely in babies who are not visibly jaundiced. […] Ensure babies with factors associated with an increased likelihood of developing significant hyperbilirubinaemia receive an additional visual inspection by a healthcare professional during the first 48 hours of life. […] In all babies with suspected or obvious jaundice in the first 24 hours of life, measure and record the serum bilirubin level urgently (within 2 hours).

• #13 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  When looking for jaundice (visual inspection): check the naked baby in bright and preferably natural light […] examine the sclerae and gums, and press lightly on the skin to check for signs of jaundice in 'blanched’ skin […] be aware that changes to skin pigmentation because of hyperbilirubinaemia may be harder to see in darker skin. […] Do not rely on visual inspection alone to estimate the bilirubin level in a baby with suspected jaundice. […] Do not measure bilirubin levels routinely in babies who are not visibly jaundiced. […] Ensure babies with factors associated with an increased likelihood of developing significant hyperbilirubinaemia receive an additional visual inspection by a healthcare professional during the first 48 hours of life. […] In all babies with suspected or obvious jaundice in the first 24 hours of life, measure and record the serum bilirubin level urgently (within 2 hours).

• #14 Infant jaundice – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-jaundice/diagnosis-treatment/drc-20373870

  Your doctor will likely diagnose infant jaundice on the basis of your baby’s appearance. However, it’s still necessary to measure the level of bilirubin in your baby’s blood. The level of bilirubin (severity of jaundice) will determine the course of treatment. […] Mild infant jaundice often disappears on its own within two or three weeks. For moderate or severe jaundice, your baby may need to stay longer in the newborn nursery or be readmitted to the hospital. […] Treatments to lower the level of bilirubin in your baby’s blood may include: Enhanced nutrition. To prevent weight loss, your doctor may recommend more-frequent feeding or supplementation to ensure that your baby receives adequate nutrition. […] Light therapy (phototherapy). Your baby may be placed under a special lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, your baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.

• #15 Jaundice in the newborn infant

  https://acutecaretesting.org/en/articles/jaundice-in-the-newborn-infant

  About half of all newborn infants born at term develop jaundice during their first days of life, and the lower the gestational age the more frequent the jaundice is. […] Jaundice appears first in the face and spreads from there down across the body and extremities to the palms of the hands and the soles of the feet. […] Only unconjugated bilirubin is toxic. […] Phototherapy is the treatment of choice. […] The 2004 guidelines from AAP (American Academy of Pediatrics) advise a systematic assessment before discharge for the risk of hyperbilirubinemia. […] The initial screening for jaundice is done visually, assessing partly its intensity and partly how far it has progressed. […] If the transcutaneous bilirubin concentration exceeds a certain limit, plasma bilirubin concentration is determined.

• #16 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  In all babies with suspected or obvious jaundice in the first 24 hours of life, continue to measure the serum bilirubin level every 6 hours until the level is both: below the treatment threshold and stable and/or falling. […] Arrange a referral to ensure that an urgent medical review is conducted (as soon as possible and within 6 hours) for babies with suspected or obvious jaundice in the first 24 hours of life to exclude pathological causes of jaundice. […] Measure and record the bilirubin level urgently (within 6 hours) in all babies more than 24 hours old with suspected or obvious jaundice. […] Use serum bilirubin measurement for babies: in the first 24 hours of life or who have a gestational age of less than 35 weeks. […] Encourage mothers of breastfed babies with jaundice to breastfeed frequently, and to wake the baby for feeds if necessary.

• #17 Neonatal Jaundice – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532930/

  Neonatal jaundice is a clinical manifestation of elevated total serum bilirubin, termed neonatal hyperbilirubinemia, which results from bilirubin that is deposited into an infant’s skin. The characteristic features of neonatal jaundice include yellowish skin, sclerae, and mucous membranes. Neonatal jaundice is usually a mild, transient, and self-limiting condition known as physiologic jaundice. However, this should be distinguished from the more severe pathologic jaundice. […] When neonatal jaundice is clinically identified, the underlying etiology of neonatal hyperbilirubinemia must be determined. Unconjugated hyperbilirubinemia is diagnosed by assessing bilirubin levels with a transcutaneous measurement device or blood samples for total serum bilirubin. Conjugated hyperbilirubinemia is typically diagnosed through laboratory studies, including serum aminotransferase, prothrombin time, urine cultures, tests for inborn errors of metabolism, and, in some cases, imaging studies. Phototherapy and exchange transfusions are the mainstays of treatment of unconjugated hyperbilirubinemia, and a subset of patients also respond to intravenous immunoglobulin (IVIG). Treatment of conjugated hyperbilirubinemia is more complex and depends on the etiology of the jaundice.

• #18 Jaundice in early infancy

  https://www.rch.org.au/clinicalguide/guideline_index/jaundice_in_early_infancy/

  Jaundice in early infancy […] If significant jaundice is clinically suspected, a serum bilirubin level should be performed as visual estimation of jaundice is unreliable. […] The majority of jaundice in well infants is physiological, and does not require investigation and management. […] Features suggestive of pathological jaundice include: onset 24 hours old, unwell baby, elevated conjugated bilirubin component, prolonged jaundice, pale stool. These require prompt investigation and management. […] Jaundice (or hyperbilirubinaemia) occurs in approximately 60% of full term and 80% of pre-term babies within the first week of life. […] Hyperbilirubinaemia occurs when there is an imbalance between bilirubin production, conjugation and elimination. […] Kernicterus is a rare complication of neonatal unconjugated hyperbilirubinaemia that can lead to major long-term neurological sequelae. […] Severity of jaundice is judged based on a newborns age and gestation, as well as clinical presentation, hydration status, and other risk factors. […] Ongoing close monitoring of weight, hydration, and bilirubin levels should be performed during treatment as per local protocol, with serial checks of SBR to ensure resolution of hyperbilirubinaemia. […] Exchange transfusion should only be performed in, or in conjunction with, a Neonatal Intensive Care Unit. […] Consider consultation with local paediatric team when the child is unwell, the cause of jaundice is unclear, or conjugated bilirubin is 10% of total level. […] Consider transfer when jaundice level rising despite adequate treatment offered at your local centre or patient needs exchange transfusion. […] Discharge advice includes that sunlight exposure is not recommended as a treatment for jaundice and to arrange early follow-up with maternal and child health nurse and/or GP to ensure adequate oral intake.

• #19 Infant jaundice – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865

  Major risk factors for jaundice, particularly severe jaundice that can cause complications, include: Premature birth. […] Breast-fed babies, particularly those who have difficulty nursing or getting enough nutrition from breast-feeding, are at higher risk of jaundice. […] The best preventive of infant jaundice is adequate feeding. Breast-fed infants should have eight to 12 feedings a day for the first several days of life.

• #20 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  Jaundice occurs in approximately 60 per cent of newborns, but only a few will require investigation and treatment. […] Jaundice may not be visible in the neonate’s skin until the bilirubin concentration exceeds 70-100 micromol/L. […] Major risk factors for severe hyperbilirubinaemia include jaundice within the first 24 hours and blood group incompatibility. […] Sunlight exposure is no longer recommended as a treatment for jaundice due to risk of sunburn or overheating. […] Late-onset jaundice must be investigated (and include both total and conjugated bilirubin levels) to exclude biliary atresia. […] If inadequately managed, jaundice may result in severe brain injury or death. […] Early detection of jaundice (appears in the sclera with SBR of 35-40 micromol/L) may be difficult in newborns because eyelids are often swollen and usually closed.

• #21 Jaundice in newborns | Caring for kids

  https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/jaundice_in_newborns

  Phototherapy is safe. Your babys eyes will be protected with special eye patches. […] Jaundice can be more serious for babies: born before 37 weeks, who weigh less than 2500 grams (5.5 lbs.) at birth, whose blood group is incompatible with their mothers blood group, who develop jaundice early in life, especially during the first 24 hours, whose jaundice has moved to the arms and legs, who have a lot of bruising or swelling under the scalp (called caput) after birth, whose siblings had jaundice at birth and needed treatment with an exchange transfusion (babys blood is removed and replaced). […] Call your doctor if your baby shows any of the following symptoms: refuses breastfeeding or bottle feeding, is very sleepy all the time, has lost a lot of weight (more than 10% of their weight at birth), is extremely jaundiced (arms and legs are a yellow or orange colour), or jaundice that seems to be getting worse.

• #22

  https://www.childrensmedicalassociation.com/caring-for-your-newborn-with-jaundice

  Caring For Your Newborn with Jaundice […] The term jaundice comes from the French word jaune, meaning yellow, and refers to a yellow discoloration of the skin and the whites of the eyes (sclera) from the deposition of the pigment called bilirubin. Bilirubin largely comes from the breakdown of hemoglobin, the protein that carries oxygen in the red blood cells. With neonatal jaundice, increase in bilirubin load resulting in hyperbilirubinemia is due to either/both an increase in bilirubin production or a decrease in bilirubin clearance. Almost all babies develop a serum bilirubin 1 mg/dl, which is the upper limit of normal for an adult. For most babies, this early rise in bilirubin is considered normal, transient and physiologic. […] Most neonatal jaundice is normal, unconjugated, and related to natural breakdown of fetal hemoglobin, immaturity of the newborn liver to efficiently metabolize bilirubin, low intake/dehydration from breast feeding, and reabsorption of bilirubin from the intestinal tract during sluggish elimination of stool. […] It is normal for most babies to have some degree of jaundice following their birth, which often peaks around 10-12 by day 4-5, though may linger for up to two weeks of age or longer (especially in breast fed babies). All babies have their bilirubin checked, measuring over the skin (transcutaneously) or by a blood test, prior to leaving the hospital: the gestational age of the newborn, the age of the baby at the time of the test, and the height of the bilirubin all determine whether the baby is at low, medium or high risk for developing significant jaundice. Your pediatrician or nurse practitioner will continue to carefully monitor your baby for jaundice once you leave the hospital. […] For babies with notable jaundice, we will repeat bilirubin levels with a blood test in the office (same day results from Quest) to monitor the height of the total/direct bilirubin. Why does it matter? Because severely elevated total bilirubin 25 mg/dl allows bilirubin to cross into the brain, which may cause brain damage (bilirubin-induced neurologic dysfunction or BIND, formerly known as kernicterus), and elevated direct bilirubin above 2mg/dl or 20% of the total may indicate a problem with the conjugation or excretion of bilirubin anyplace within the liver/biliary system (cholestasis), which must be identified/treated quickly to minimize liver damage. […] Again, most jaundice in newborns is benign and transient. Risk factors for more severe hyperbilirubinemia include prematurity; maternal diabetes; race (Asians and Native Americans); male sex; trisomy 21 (Down Syndrome); blood in the scalp following vaginal delivery (cephalohematoma); hemolysis (abnormal breakdown of blood cells, e.g., one such cause is if the baby and mom have different blood types – ABO and/or Rh – and antibodies against the babys blood type cross the placenta and attack red blood cells in the baby); oxytocin induction; breast feeding; delayed passage of meconium; gene mutations; and a history of siblings who had neonatal jaundice. […] So what should you expect if your baby has newborn jaundice? We will take a detailed history of the pregnancy, labor and delivery, feeding and elimination patterns, review blood group incompatibilities, and obtain your family history, all for identifying risk factors for elevated bilirubin. We will perform a complete physical examination of the baby, noting the color of the skin/eyes, the size and feel of the liver and spleen, and the presence of rash or other signs of congenital infection. We will monitor your babys bilirubin, both clinically and with same-day blood testing (total and direct bilirubin) sent to Quest from the office. Most of the time that is sufficient, and the jaundice resolves. […] Occasionally babies with unconjugated hyperbilirubinemia will be treated with blue-light phototherapy in the hospital to aide in the reduction of the serum bilirubin, and that therapy may be extended with the use of a bili blanket upon discharge home. Putting your baby near a window with indirect light is also helpful, as is increasing the volume or frequency of feeding to improve hydration, stimulate the production of stool, and decrease reabsorption of bilirubin from the gut back to the bloodstream. […] If your newborns examination is abnormal, if the jaundice continues past two weeks, or if there is cholestasis, we will request additional labwork to assess hemolysis, liver function, metabolic disorders, or the presence of infection. We may order an ultrasound of the liver and gall bladder to look at the structures, assess the presence/patency of bile ducts, and determine any other mechanical cause of cholestasis. Other more complex radiology studies may be necessary. Rarely, liver biopsy may be required. For newborns with persistent or pathological jaundice, we will enlist the help of a pediatric gastroenterologist to help manage the evaluation and your babys ongoing care. […] Remember that newborn jaundice is generally normal, transient, and benign. If you have questions or concerns, we are here for you. Reach out on the portal or schedule an appointment to come see us in the office if you are wondering about how to best care for your newborn with jaundice.

• #23 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Understanding Hyperbilirubinemia: Develop a clear understanding of the pathophysiology of hyperbilirubinemia in newborns, including the normal physiological jaundice and potential complications. […] Risk Factors Identification: Identify and recognize the risk factors associated with neonatal hyperbilirubinemia, such as prematurity, ABO/Rh incompatibility, breastfeeding issues, and maternal diabetes, to facilitate early detection and intervention. […] Assessment Skills: Acquire skills in assessing jaundice in newborns through systematic clinical evaluation, including visual inspection, transcutaneous bilirubin measurement, and laboratory tests. […] Intervention Strategies: Learn evidence-based nursing interventions for managing hyperbilirubinemia, including phototherapy administration, monitoring bilirubin levels, and providing support for breastfeeding mothers.

• #24 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Communication and Education: Develop effective communication skills to educate parents about the causes, signs, and management of neonatal hyperbilirubinemia. Provide support and guidance for parents in caring for their jaundiced newborns at home. […] The primary goal is to reduce and maintain bilirubin levels within the normal range for the infants age, minimizing the risk of bilirubin-induced neurotoxicity. […] Achieve the resolution of jaundice, ensuring that the yellow discoloration of the skin and sclera diminishes as bilirubin levels decrease. […] Regular monitoring for potential complications, such as kernicterus or acute bilirubin encephalopathy, and promptly addressing any signs or symptoms to prevent long-term neurological damage. […] Provide thorough education to parents or caregivers regarding the importance of monitoring feeding, promoting adequate hydration, and recognizing signs of worsening jaundice. This empowers parents to actively participate in the care of their newborn.

• #25 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Establish effective communication and collaboration between healthcare providers, including pediatricians, neonatologists, and nursing staff, to ensure a coordinated approach to monitoring and managing hyperbilirubinemia in the newborn. […] Monitor and document serum bilirubin levels regularly, paying close attention to trends and changes over time. […] Perform a thorough clinical assessment, including a physical examination to evaluate the extent and progression of jaundice. Note the presence of yellow discoloration in the skin and sclera. […] Identify and assess potential risk factors for hyperbilirubinemia, such as prematurity, ABO or Rh incompatibility, exclusive breastfeeding, and a family history of jaundice. […] Evaluate the infants feeding patterns, ensuring adequate intake and addressing any issues related to breastfeeding or formula feeding that may contribute to dehydration or insufficient caloric intake.

• #26 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Monitor the frequency and characteristics of the infants bowel movements and urination to assess the elimination of bilirubin. […] Perform a focused neurological assessment to identify any signs of acute bilirubin encephalopathy or kernicterus, such as changes in muscle tone, irritability, poor feeding, or abnormal reflexes. […] Assess the newborns skin color and tone, particularly in areas where jaundice may be less apparent, such as the palms and soles. […] Actively engage with parents to gather information about any concerns they may have, address misconceptions, and provide education on the importance of monitoring and reporting changes in the infants condition. […] Initiate phototherapy as prescribed, ensuring the newborn is exposed to the therapeutic light source for the prescribed duration. Monitor the effectiveness of phototherapy by regularly assessing bilirubin levels.

• #27

• #28 Neonatal jaundice – MedCrave online

  https://medcraveonline.com/NCOAJ/neonatal-jaundice.html

  Assess fluid volume status of child by intake and output chart […] Providing proper intravenous fluid to child […] Providing proper fluid to child […] Maintaining intake and output chart […] Assess the skin integrity of child […] Providing proper care to child […] Changing position every hourly to prevent skin breakdown […] Apply powder to skin and back care to prevent skin integrity […] Applying emollient cream to child skin […] Assess the body temperature of child by thermometer […] Providing cold compress to child […] Providing tepid sponge to child […] Maintain proper ventilation in ward […] Providing antipyretic as per physician order […] Assess the knowledge of parents by asking question […] Providing psychological support to parents […] Explain regarding hospital rules and regulation […] Explain about treatment of child to parents […] Providing diversional therapy to child and parents e.g.: books, music, TV.

• #29 Infant jaundice – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-jaundice/diagnosis-treatment/drc-20373870

  When infant jaundice isn’t severe, your doctor may recommend changes in feeding habits that can lower levels of bilirubin. Talk to your doctor if you have any questions or concerns about how much or how often your baby is feeding or if you’re having trouble breast-feeding. The following steps may lessen jaundice: More-frequent feedings. Feeding more frequently will provide your baby with more milk and cause more bowel movements, increasing the amount of bilirubin eliminated in your baby’s stool. […] If risk factors for severe jaundice are present, your doctor may recommend a follow-up visit a day or two after the baby leaves the hospital. […] Is the jaundice severe? […] Does my baby need to begin treatment for jaundice? […] Will I need to readmit my baby to the hospital?

• #30 A Practical Approach to Neonatal Jaundice | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0501/p1255.html

  Outpatient evaluation should include follow-up on weight, intake, voiding, and stooling. A TSB or TcB level should be obtained in the outpatient setting if jaundice is increasing or if the clinical assessment is unclear as to the severity of jaundice. […] All newborn nurseries need to establish a protocol for identifying and evaluating hyperbilirubinemia. Some institutions with such a protocol report a reduced proportion of neonates with hyperbilirubinemia, its complications, and subsequent hospitalizations. […] For infants with mild jaundice (i.e., when the bilirubin level is not approaching the threshold for phototherapy), increasing the frequency of feedings is indicated. Breast-fed infants should continue breastfeeding, whether or not they require phototherapy. Infants with inadequate oral intake, excessive weight loss (more than 12 percent of birth weight), or dehydration should receive supplemental breast milk or formula; supplementation with water or dextrose water is not recommended.

• #31 Jaundice and Breastfeeding | Breastfeeding special circumstances | CDC

  https://www.cdc.gov/breastfeeding-special-circumstances/hcp/illnesses-conditions/jaundice.html

  Most newborns with jaundice can continue breastfeeding. […] Supplementation may include the mother’s expressed breast milk, pasteurized donor human milk, or infant formula. […] In most cases, breastfeeding can, and should, continue. More feedings can reduce the risk of jaundice. […] Ongoing clinical assessment, including repeat bilirubin level measurements, will help determine when breastfeeding can resume. […] If a temporary breastfeeding interruption is required, it is critical to help mothers maintain their milk production through pumping or hand expression during this time. […] Health care providers should make decisions about supplementation of a jaundiced newborn on a case-by-case basis. […] Supplementation can include the mother’s expressed breast milk, pasteurized donor human milk, or infant formula.

• #32 Patient education: Jaundice in newborn infants (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics

  At low levels, bilirubin is not harmful. Complications only occur in babies whose blood bilirubin levels reach harmful levels. […] The goal of treating jaundice is to efficiently and safely reduce the level of bilirubin in the blood before it becomes toxic. […] Frequent feeding — Providing adequate milk is an important part of preventing and treating jaundice because it helps in the removal of bilirubin in stools and urine. […] Phototherapy — Phototherapy is the most common medical treatment for hyperbilirubinemia in babies. […] Phototherapy is usually given in a hospital. […] Phototherapy is stopped when bilirubin levels in the blood drop to a safe level. […] It is important for babies receiving phototherapy to drink adequate fluids (ideally breast milk) since bilirubin is eliminated in urine and stool.

• #33 Hyperbilirubinemia in Pediatrics Nursing CEU – Nursing CE Central

  https://nursingcecentral.com/lessons/hyperbilirubinemia-in-pediatrics/

  In addition to closely monitoring feedings, it is important for the nurse to closely monitor urine and stool output. […] This is important to ensure that the infant is properly excreting waste and hydrating. […] Treating hyperbilirubinemia in the newborn includes the following interventions: Adequate nutrition, Phototherapy, Exchange transfusion. […] Phototherapy is the most common intervention used to treat jaundice and hyperbilirubinemia of the newborn. […] The key benefit to phototherapy is reducing TSB levels and preventing TSB levels from rising to a level in which an exchange transfusion is indicated. […] Nurses should be mindful of ways to maximize the benefits of phototherapy. […] It is important to: Place infant supine. Maximize skin exposure size down on diaper. Cover infants eyes with an eye shield. Monitor the infant during therapy. If applicable, time spent off phototherapy for feeds. Limit to 30 minutes or less.

• #34 Phototherapy for neonatal jaundice

  https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/phototherapy_for_neonatal_jaundice/

  This guideline applies to neonates within the first two weeks of life. Phototherapy is the use of visible light to treat severe jaundice in the neonatal period. Approximately 60% of term babies and 85% preterm babies will develop clinically apparent jaundice, which classically becomes visible on day 3, peaks days 5-7 and resolves by 14 days of age in a term infant and by 21 days in the preterm infant. Treatment with phototherapy is implemented in order to prevent the neurotoxic effects of high serum unconjugated bilirubin. Phototherapy is a safe, effective method for decreasing or preventing the rise of serum unconjugated bilirubin levels and reduces the need for exchange transfusion in neonates. […] This guideline provides health care providers with information to understand the causes of neonatal jaundice, the rationale for the use of phototherapy and outlines the care of neonates receiving phototherapy in order to enhance effective phototherapy delivery and minimise complications of phototherapy.

• #35 Nursing care of_hyperbilirubinemia | PDF

  https://www.slideshare.net/slideshow/nursing-care-ofhyperbilirubinemia-65591482/65591482

  Nursing care of newborn with Hyperbilirubinemia Hyperbilirubinemia is a condition in which the bilirubin level in the blood is increased. It is characterized by a yellow discoloration of the skin, mucous membrane, sclera, and various organs. The yellow discoloration is caused primarily by accumulation in the skin of unconjugated bilirubin, a breakdown product of hemoglobin forming after its release from hemolysed RBCs. […] Management of hyperbilirubinaemia: 1. Increase feeds in volume and calories. Early feeding lowers serum bilirubin level by stimulating the peristalsis. 2. Stop drugs interfering with bilirubin metabolism. 3. Correct hypoxia, infection, and acidosis. 4. Phototherapy. […] Nurses responsibility in phototherapy: 1. The lamp should be 5-8 cm over the incubator. 2. Continue the feeding. 3. Shield the newborn’s eyes. 4. Keep newborn naked except for the diaper area and change position frequently. 5. Cleanse skin frequently to prevent irritation. 6. Maintain adequate fluid intake to prevent dehydration and calculate intake and output. 7. Check newborn’s body temperature every four hours. 8. Weight newborn daily. 9. Observe skin, mucous membranes, and stool. 10. Bilirubin levels should be followed for at least 24 hours after discontinuing phototherapy.

• #36 Phototherapy for neonatal jaundice

  https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/phototherapy_for_neonatal_jaundice/

  Breastfed babies who require phototherapy should continue to breastfeed unless clinically contra-indicated due to other pathology; the neonates sucking, attachment and mothers milk supply should be monitored. In the case of infants nearing exchange transfusion level, the infant should not come out of phototherapy to feed as this is a medical emergency. All feeds should be given via a bottle or NGT if feeding is deemed safe. […] Commence phototherapy once SBR is greater than the appropriate reference range for neonates gestation/weight and presence of risk factors. […] Ensure eye covers are removed 4-6 hourly for eye care during infant cares or feeding. Observe for discharge/infection/damage and document any changes. […] Documentation in the neonates discharge letter and Child Health Booklet should include details about SBR levels and duration of phototherapy treatment. Normal hand hygiene should be attended to during care of neonate receiving phototherapy.

• #37 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Encourage and support breastfeeding, ensuring that the newborn is adequately fed. If necessary, supplement with formula to promote effective calorie intake and reduce the risk of dehydration. […] Implement a systematic monitoring plan for bilirubin levels, feeding patterns, and elimination. Document changes in clinical status, response to interventions, and any concerns raised by parents. […] Educate parents about the importance of phototherapy, feeding, and the significance of regular follow-up appointments. Provide clear instructions on recognizing signs of worsening jaundice or other concerning symptoms. […] Collaborate with pediatricians, neonatologists, and other healthcare team members to ensure a coordinated approach to care. Participate in regular team discussions to review the infants progress and adjust the care plan as needed.

• #38 Hyperbilirubinemia Symptoms, Treatment, Phototherapy, Care – LevelUpRN

  https://leveluprn.com/blogs/maternity-nursing/newborn-5-hyperbilirubinemia-symptoms-treatment-phototherapy-nursing-care?srsltid=AfmBOop3MJthtRuCKAhCOaYlTRsWMS12M_i6xcat2liU4CZPBv4quJkV

  The nursing care associated with phototherapy to treat hyperbilirubinemia. […] Nursing care would be: we need to know when did the jaundice start, right? Was it before 24 hours of life or after? Big deal. And then, we need to provide care during phototherapy, which we will talk about in a minute. […] So lastly, let’s talk about phototherapy and what that entails from a nursing perspective. So phototherapy is placing the baby under UV lights, and that’s going to help to break down bilirubin. […] As with any sort of patient at all, we need to make sure that we’re turning them every two hours, right, so we don’t have pressure injuries. We need to monitor baby’s temperature. […] We would, of course, keep rechecking those bilirubin levels every 6 to 12 hours. […] We need to make sure baby is having all of their basic physiological needs met.

• #39 Nursing care of_hyperbilirubinemia | PDF

  https://www.slideshare.net/slideshow/nursing-care-ofhyperbilirubinemia-65591482/65591482

  Nursing responsibilities: 1. Keep the newborn npo for 2-4 hours before exchange to prevent aspiration. 2. Check donor blood carts compatibility. 3. Keep resuscitation equipment at bedside: oxygen, ambo bag, endotracheal tubes, and laryngoscope. 4. Assist physician with exchange transfusion procedure. 5. Track amount of blood withdrawn and transfused to maintain balanced blood volume. 6. Maintain body temperature to avoid hypothermia and cold stress. 7. Monitor vital signs and observe for rash. 8. After transfusion, continue to monitor vital signs and check umbilical cord for bleeding or signs of infection. […] Expected Outcomes: Infant exhibits no signs of adverse effects from exchange transfusion. Vital signs remain within normal limits. There is no evidence of infection or bleeding at infusion site.

• #40 Neonatal Jaundice Treatment & Management: Approach Considerations, Medical Care, Phototherapy

  https://emedicine.medscape.com/article/974786-treatment

  Surgical care is not indicated in infants with physiologic neonatal jaundice. However, operative intervention is indicated in infants whose jaundice is caused by bowel or external bile duct atresia. […] For infants with physiologic neonatal jaundice, no consultation is required. Consult gastroenterologists and surgeons regarding infants with jaundice resulting from hepatobiliary or bowel disease. […] Infants in need of exchange transfusion who are born at or admitted to facilities not capable of performing this procedure should be transferred to the nearest facility with such capability. In addition to complete records, the infant should be accompanied by a sample of maternal blood which is needed by the blood bank to match blood. […] If the infant is in imminent danger of kernicterus, or is already exhibiting signs of neurologic compromise, immediately initiate the most efficient phototherapy possible under the circumstances, and continue it until transfer commences.

• #41 Neonatal Jaundice Treatment & Management: Approach Considerations, Medical Care, Phototherapy

  https://emedicine.medscape.com/article/974786-treatment

  If the hyperbilirubinemia is due to blood group isoimmunization, immediately start an infusion of intravenous immunoglobulin (IVIG) at 500 mg/kg, and continue it before and during transfer until completed (2 hours). […] Phototherapy, IVIG, and exchange transfusion are the most widely used therapeutic modalities in infants with neonatal jaundice. […] Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. […] Phototherapy can be administered in a number of ways. […] Key points in the practical execution of phototherapy include maximizing energy delivery and the available surface area. […] The infant should be naked except for diapers (use these only if deemed absolutely necessary and cut them to the minimum workable size), and the eyes should be covered to reduce risk of retinal damage.

• #42 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Neonatal jaundice is the main reason for admission from home to a neonatal unit. Many neonates are readmitted with extreme hyperbilirubinemia or bilirubin encephalopathy at or around day five and had been discharged as healthy from birth hospitalization. […] Parents need guidance throughout the infants hospitalization to help to prepare them for this new experience. The mother is usually concerned with her ability to care for such a small and helpless creature. When she feels ready, she may assist the nurse in diapering, bathing, feeding, and other activities. Often the mother is discharged without her infant. This is difficult for the entire family and complicates attachment and bonding. […] Provide parents with an appropriate written explanation of home phototherapy, listing technique and potential problems, and safety precautions. Non-specific written instructions are most likely a key factor contributing to the low attendance rate for early community follow-up for jaundice, as studied by Kaplan et al.. Some mothers provided reasons contributing to poor attendance. Poor understanding and insufficient explanation of the potential dangers of hyperbilirubinemia were leading factors. It is possible that the medical/nursing team, at the time of discharge, did not fully expound to parents the full reasons necessitating early follow-up (Kaplan et al., 2019).

• #43 Phototherapy for neonatal jaundice

  https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/phototherapy_for_neonatal_jaundice/

  Explain to parents the need for and actions of phototherapy, particularly in relation to the need for skin surface to be exposed to the phototherapy light, and hence the need to care for neonates receiving phototherapy to be nursed in a neutral thermal environment. Potential complications of phototherapy and the need for protective eye coverings during phototherapy treatment should be explained.

• #44 Neonatal Jaundice: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/974786-overview

  Educate parents about neonatal jaundice and provide written information prior to discharge from the birth hospital. The parent information leaflet should preferably be available in several languages. […] A novel two-color icterometer (Bilistrip) appears to have the potential to facilitate early maternal detection of clinically significant jaundice and help them in decision making to seek medical treatment. […] Several smartphone applications have been developed to assess neonatal jaundice (BiliCam, BiliScan, Picterus, and neoSCB). These show promise for effectively screening newborns for neonatal jaundice.

• #45 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  Offer parents or carers information about neonatal jaundice that is tailored to their needs and expressed concerns. This information should be provided through verbal discussion backed up by written information. Care should be taken to avoid causing unnecessary anxiety to parents or carers. Information should include: […] Ensure that adequate support is offered to all women who intend to breastfeed exclusively. For information on breastfeeding support, see NICE’s guideline on postnatal care. […] In all babies: check whether there are factors associated with an increased likelihood of developing significant hyperbilirubinaemia soon after birth […] examine the baby for jaundice at every opportunity especially in the first 72 hours. […] Parents, carers and healthcare professionals should all look for jaundice (visual inspection) in babies.

• #46 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Discuss home management of mild or moderate physiological jaundice, including increased feedings, diffused exposure to sunlight (checking infant frequently), and a follow-up serum testing program. […] Provide information about maintaining milk supply through a breast pump and reinstating breastfeeding when jaundice necessitates interruption of breastfeeding. This helps mothers maintain adequate milk supply to meet the infants needs when breastfeeding is resumed. Infants weighing more than 1500 g (3.3 lb) may be able to bottle feed if a small, soft nipple with a large hole is used to minimize the energy and effort required for sucking. Breast milk may be manually expressed by the mother and placed in a bottle for her preterm infant. […] Discuss the need for Rh immune globulin (RhIg) within 72 hours following delivery for an Rh-negative mother with an Rh-positive infant who has not been previously sensitized. Rh-Ig may minimize the incidence of maternal isoimmunization in non-sensitized mothers and may help to prevent erythroblastosis fetalis in subsequent pregnancies. […] Provide appropriate referral for a home phototherapy program, if necessary. The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program.

• #47 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  Provide lactation/feeding support to breastfeeding mothers whose baby is visibly jaundiced. […] Use the bilirubin level to determine the management of hyperbilirubinaemia in all babies (see the threshold table and the treatment threshold graphs). […] Do not use the albumin/bilirubin ratio when making decisions about the management of hyperbilirubinaemia. […] Do not subtract conjugated bilirubin from total serum bilirubin when making decisions about the management of hyperbilirubinaemia (see management thresholds in the threshold table and the treatment threshold graphs). […] During phototherapy: repeat serum bilirubin measurement 46 hours after initiating phototherapy […] repeat serum bilirubin measurement every 612 hours when the serum bilirubin level is stable or falling. […] Stop phototherapy once serum bilirubin has fallen to a level at least 50 micromol/litre below the phototherapy threshold.

• #48 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Discuss home management of mild or moderate physiological jaundice, including increased feedings, diffused exposure to sunlight (checking infant frequently), and a follow-up serum testing program. […] Provide information about maintaining milk supply through a breast pump and reinstating breastfeeding when jaundice necessitates interruption of breastfeeding. This helps mothers maintain adequate milk supply to meet the infants needs when breastfeeding is resumed. Infants weighing more than 1500 g (3.3 lb) may be able to bottle feed if a small, soft nipple with a large hole is used to minimize the energy and effort required for sucking. Breast milk may be manually expressed by the mother and placed in a bottle for her preterm infant. […] Discuss the need for Rh immune globulin (RhIg) within 72 hours following delivery for an Rh-negative mother with an Rh-positive infant who has not been previously sensitized. Rh-Ig may minimize the incidence of maternal isoimmunization in non-sensitized mothers and may help to prevent erythroblastosis fetalis in subsequent pregnancies. […] Provide appropriate referral for a home phototherapy program, if necessary. The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program.

• #49 Newborn jaundice – discharge Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/discharge-instructions/newborn-jaundice-discharge

  Your baby has newborn jaundice. This common condition is caused by high levels of bilirubin in the blood. Your child’s skin and sclera (whites of their eyes) will look yellow. […] To help break down the bilirubin, your child will be placed under bright lights (phototherapy) in a warm, enclosed bed. The infant will wear only a diaper and special eye shades. Your baby may have an intravenous (IV) line to give them fluids. […] If the bilirubin level is not too high or not rising quickly, you can do phototherapy at home with a fiber optic blanket, which has tiny bright lights in it. […] You must keep the light therapy on your child’s skin and feed your child every 2 to 3 hours (10 to 12 times a day). Feeding prevents dehydration and helps bilirubin leave the body. […] Therapy will continue until your baby’s bilirubin level lowers enough to be safe. Your baby’s provider will want to check the level again in 2 to 3 days. […] Contact your baby’s health care provider if the infant: Has a yellow color that goes away, but then returns after treatment stop. […] Also contact your baby’s provider if you have concerns, if the jaundice is getting worse, or the baby: Is lethargic (hard to wake up), less responsive, or fussy.

• #50 Newborn jaundice – discharge Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/discharge-instructions/newborn-jaundice-discharge

  Your baby has newborn jaundice. This common condition is caused by high levels of bilirubin in the blood. Your child’s skin and sclera (whites of their eyes) will look yellow. […] To help break down the bilirubin, your child will be placed under bright lights (phototherapy) in a warm, enclosed bed. The infant will wear only a diaper and special eye shades. Your baby may have an intravenous (IV) line to give them fluids. […] If the bilirubin level is not too high or not rising quickly, you can do phototherapy at home with a fiber optic blanket, which has tiny bright lights in it. […] You must keep the light therapy on your child’s skin and feed your child every 2 to 3 hours (10 to 12 times a day). Feeding prevents dehydration and helps bilirubin leave the body. […] Therapy will continue until your baby’s bilirubin level lowers enough to be safe. Your baby’s provider will want to check the level again in 2 to 3 days. […] Contact your baby’s health care provider if the infant: Has a yellow color that goes away, but then returns after treatment stop. […] Also contact your baby’s provider if you have concerns, if the jaundice is getting worse, or the baby: Is lethargic (hard to wake up), less responsive, or fussy.

• #51 Jaundice in Newborns: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/22263-jaundice-in-newborns

  You should contact your babys healthcare provider if their jaundice increases or lasts longer than two weeks. Symptoms of severe jaundice may include: Your babys skin turns brighter yellow or orange. Your baby is very sleepy, including difficult to wake for feeds. Your baby is very fussy. Your baby isnt nursing well or sucking from a bottle well. Your baby isnt making enough wet and/or dirty diapers. […] If your newborn babys jaundice hasnt improved or seems worse, call your babys healthcare provider right away. They can give your baby another bilirubin test to ensure theyre on their way to good health.

• #52 Newborn jaundice – discharge – UF Health

  https://ufhealth.org/care-sheets/newborn-jaundice-discharge

  Contact your baby’s health care provider if the infant: […] Has a yellow color that goes away, but then returns after treatment stop […] Has a yellow color that lasts for more than 2 to 3 weeks. […] Also contact your baby’s provider if you have concerns, if the jaundice is getting worse, or the baby: […] Is lethargic (hard to wake up), less responsive, or fussy […] Refuses the bottle or breast for more than 2 feedings in a row […] Is losing weight […] Has watery diarrhea.

• #53 Patient education: Jaundice in newborn infants (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics

  Approximately 80 percent of babies have visible jaundice, which usually resolves by seven days of age. Only 10 to 15 percent of babies develop bilirubin levels that require treatment. […] Your baby should be taken to see a doctor or nurse for a checkup within one to three days after going home. […] Signs of worsening jaundice — Call your baby’s doctor if your baby has jaundice and any of the following occurs: […] Jaundice is caused by the buildup of bilirubin in the blood, which can lead to its buildup in the body’s tissues (such as skin). […] Breastfeeding — Jaundice is normally seen in breastfed babies for two key reasons: […] Babies with jaundice due to breastfeeding rarely need treatment aside from increasing breast milk intake as needed, unless there is a risk of developing severe hyperbilirubinemia.

• #54 Neonatal Jaundice | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23803

  Neonatal jaundice is usually a mild, transient, and self-limiting condition known as physiologic jaundice. […] However, this should be distinguished from the more severe pathologic jaundice. […] Failure to identify and treat pathologic jaundice may result in bilirubin encephalopathy and associated neurological sequelae. […] Phototherapy and exchange transfusions are the mainstays of treatment of UHB, and a subset of patients also respond to intravenous immunoglobulin (IVIG). […] Treatment of CHB is more complex and depends on the etiology of the jaundice. […] Despite advances in the care and management of hyperbilirubinemia, it remains a significant cause of neonatal morbidity and mortality. […] The American Academy of Pediatrics (AAP) recommends universal visual screening of all newborns for jaundice every 12 hours from the time of birth until the infant is discharged home.

• #55

  https://www.nhs.uk/conditions/jaundice-newborn/treatment/

  Speak to your midwife, health visitor or GP if your baby develops jaundice. They’ll be able to assess whether treatment is needed. […] Treatment is usually only needed if your baby has high levels of a substance called bilirubin in their blood, so tests need to be carried out to check this. […] Most babies with jaundice do not need treatment because the level of bilirubin in their blood is found to be low. […] If treatment is not needed, you should continue to breastfeed or bottle feed your baby regularly, waking them up for feeds if necessary. […] If your baby’s jaundice does not improve over time, or tests show high levels of bilirubin in their blood, they may be admitted to hospital and treated with phototherapy or an exchange transfusion. […] These treatments are recommended to reduce the risk of a rare but serious complication of newborn jaundice called kernicterus, which can cause brain damage.

• #56 Jaundice in Newborns (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/jaundice.html

  Mild jaundice goes away after 1 or 2 weeks as a baby’s body gets rid of the extra bilirubin on its own. […] For newborns with breastfeeding jaundice, mothers should breastfeed the baby more often. […] If the baby is not getting enough breast milk, the doctor may suggest supplementing with formula. […] For more serious cases of jaundice, treatment should start as soon as possible. […] Babies may get: fluids. A loss of fluids (dehydration) will cause bilirubin levels to rise. […] phototherapy. Babies lie under lights with little clothing so their skin is exposed. […] exchange blood transfusion. This emergency procedure is done if very high bilirubin levels do not come down with phototherapy. […] Call the doctor if your baby has jaundice that isn’t going away. Babies with jaundice for longer than 2 weeks need more testing to check for other things that cause jaundice.

• #57 Breast Milk Jaundice (Nursing) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK568792/

  By the end of this activity, the participant will be able to: […] Discuss the nursing management of breastmilk jaundice. […] Nursing management includes providing education and support for the parents of infants with jaundice. […] In the rare cases where an infant needs to stop breastfeeding for 24 hours, nurses need to educate the mother on proper pumping procedure and safe storage of breastmilk. […] The mother may need breastfeeding assistance, and referral to a lactation consultant is a good option in areas where that is available. […] Education on infant bathing and appropriate diapering and skincare to prevent breakdown is important. […] Notify the provider if jaundice is visible in an infant less than 24 hours of age. […] Close communication between all members of the health care team and the parents is necessary to rule out other causes of neonatal hyperbilirubinemia. […] Parents of affected patients should be educated about the nature of the condition. […] The nurse will continue to teach the parents routine infant care and assist with breastfeeding. […] Nursing measures supportive of parents and breastfeeding are expected.

• #58 Jaundice – La Leche League International

  https://llli.org/breastfeeding-info/jaundice/

  Physiologic jaundice occurs more frequently in breastfed than formula fed babies. It occurs, in particular, among babies who do not nurse frequently in the first days of life or are not breastfeeding well and who continue to lose weight. Frequent and effective breastfeeding in the early days helps baby’s body eliminate bilirubin. […] The first step is to encourage the jaundiced baby to nurse more often (at least 10 to 12 times in 24 hours) and more effectively (check to see if baby is latched-on and sucking well) to reduce bilirubin levels as soon as possible. […] Phototherapy is the most frequently used treatment when bilirubin exceeds thresholds. Phototherapy uses special lights to break down the bilirubin stored in baby’s skin so that it can be eliminated more easily. […] If the baby is not breastfeeding actively despite this help, milk expression may be needed to initiate adequate milk production and possibly to supplement breastfeeding.

• #59 Jaundice in early infancy

  https://www.rch.org.au/clinicalguide/guideline_index/jaundice_in_early_infancy/

  Jaundice in early infancy […] If significant jaundice is clinically suspected, a serum bilirubin level should be performed as visual estimation of jaundice is unreliable. […] The majority of jaundice in well infants is physiological, and does not require investigation and management. […] Features suggestive of pathological jaundice include: onset 24 hours old, unwell baby, elevated conjugated bilirubin component, prolonged jaundice, pale stool. These require prompt investigation and management. […] Jaundice (or hyperbilirubinaemia) occurs in approximately 60% of full term and 80% of pre-term babies within the first week of life. […] Hyperbilirubinaemia occurs when there is an imbalance between bilirubin production, conjugation and elimination. […] Kernicterus is a rare complication of neonatal unconjugated hyperbilirubinaemia that can lead to major long-term neurological sequelae. […] Severity of jaundice is judged based on a newborns age and gestation, as well as clinical presentation, hydration status, and other risk factors. […] Ongoing close monitoring of weight, hydration, and bilirubin levels should be performed during treatment as per local protocol, with serial checks of SBR to ensure resolution of hyperbilirubinaemia. […] Exchange transfusion should only be performed in, or in conjunction with, a Neonatal Intensive Care Unit. […] Consider consultation with local paediatric team when the child is unwell, the cause of jaundice is unclear, or conjugated bilirubin is 10% of total level. […] Consider transfer when jaundice level rising despite adequate treatment offered at your local centre or patient needs exchange transfusion. […] Discharge advice includes that sunlight exposure is not recommended as a treatment for jaundice and to arrange early follow-up with maternal and child health nurse and/or GP to ensure adequate oral intake.

• #60 Neonatal Jaundice: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/974786-overview

  Jaundice is the most common condition that requires medical attention and hospital readmission in newborns. The yellow coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin. In most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon. However, in some infants, serum bilirubin levels may rise excessively, which can be cause for concern because unconjugated bilirubin IX (Z,Z) is neurotoxic and can cause death in newborns and lifelong neurologic sequelae in infants who survive (kernicterus). For these reasons, the presence of neonatal jaundice frequently results in diagnostic evaluation. […] Neonatal jaundice, although a normal transitional phenomenon in most infants, can occasionally become more pronounced. Blood group incompatibilities (eg, Rh, ABO) may increase bilirubin production through increased hemolysis.

• #61

  https://www.nhs.uk/conditions/jaundice-newborn/treatment/

  Phototherapy is treatment with a special type of light (not sunlight). […] It’s sometimes used to treat newborn jaundice by making it easier for your baby’s liver to break down and remove the bilirubin from your baby’s blood. […] Phototherapy aims to expose your baby’s skin to as much light as possible. […] If your baby’s jaundice does not improve, intensified phototherapy may be offered. […] Treatment cannot be stopped for breaks during intensified phototherapy, so you will not be able to breastfeed or hold your baby. […] Phototherapy is generally very effective for newborn jaundice and has few side effects. […] If your baby has a very high level of bilirubin in their blood or phototherapy has not been effective, they may need a complete blood transfusion, known as an exchange transfusion.

• #62 Neonatal Jaundice Management

  https://ceufast.com/course/neonatal-jaundice-management

  Pathologic UHB occurs much more rarely, often presents within the first 24 hours of life, and increases rapidly. […] For full term, healthy neonates over 24 hours of age and determined to be exhibiting non-pathologic jaundice, management can safely take place in the outpatient setting. […] Phototherapy uses blue-green light waves to alter bilirubin molecules and make them water-soluble and ready for excretion without needing to be conjugated in the hepatic system. […] For infants suspected of exhibiting pathologic jaundice, close hospital management with neonatology is indicated. […] If bilirubin levels start to approach those associated with kernicterus despite phototherapy, exchange transfusion may be necessary to protect the jaundiced infant’s CNS status. […] With prompt identification and treatment, UHB is extremely treatable, and prognosis is excellent. […] A solid foundation of knowledge for how to identify and manage neonatal hyperbilirubinemia is necessary for any nurse working in a maternal-newborn or pediatric setting.

• #63 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  All infants receiving phototherapy must have a serum bilirubin level measured as well as basic investigations to exclude the common causes of unconjugated hyperbilirubinemia. […] The commencement of phototherapy necessitates further investigation for a cause. […] Treatment for jaundice includes: treatment of the cause (such as infection or hypothyroidism), adequate enteral hydration may reduce enterohepatic circulation of bilirubin, phototherapy, exchange transfusion. […] Exposure of jaundiced skin to light photo-isomerises the bilirubin molecule into forms which can be excreted directly into the bile, without having to be conjugated. […] The effectiveness of phototherapy increases with blue light (460-490 nm) and intensity of the light. […] The major drawback with phototherapy is that its effect is slow.

• #64 Neonatal Jaundice | ACG

  https://gi.org/topics/neonatal-jaundice/

  If the unconjugated or indirect bilirubin level remains high or is increasing, the baby may need further treatment to decrease the bilirubin level. Treatments might include: […] Phototherapy is a treatment that allows the bilirubin under the skin to be broken down by a special light that illuminates the baby’s body. These lights are usually blue-green. They are placed about 4 inches above the baby. The more skin that is exposed to the lights, the better they work to break down a larger amount of unconjugated or indirect bilirubin. The lights do not prevent the baby from drinking formula or being breast-fed. The baby can be safely removed from the phototherapy at feeding times without decreasing the efficacy of the treatment. […] For a few babies, the level of unconjugated or indirect bilirubin is so high (greater than 20-25 mg/dl) that physicians are concerned about brain damage. The level has to be brought down very fast using a technique called exchange transfusion. An exchange transfusion is performed in the neonatal intensive care unit. The baby’s blood is exchanged and replaced very slowly and carefully with a donor’s blood. This allows for the indirect bilirubin to be removed faster, which will decrease the risk of further complications. This treatment is reserved for the most serious cases at risk for developing kernicterus (a condition where the indirect bilirubin is stored in areas of the brain and causes abnormal movements and seizures.)

• #65 Neonatal Jaundice | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23803

  All newborns should undergo an appropriate evaluation for possible jaundice before hospital discharge. […] Phototherapy (PT) remains the first-line treatment for managing pathologic unconjugated hyperbilirubinemia. […] Phototherapy is considered safe, but recent evidence suggests a possible association with long-term sequelae, including a small risk of epilepsy. […] Intravenous immunoglobulin (IVIG) is used when immune-mediated hemolysis is the cause of unconjugated hyperbilirubinemia, which prevents RBC hemolysis by coating Fc receptors on RBCs. […] The prognosis for conjugated hyperbilirubinemia depends on the etiology. […] The prognosis of patients with biliary atresia is significantly improved by early diagnosis and surgery within 60 days of life. […] Most cases are self-limiting with an excellent prognosis. […] However, bilirubin encephalopathy is an uncommon but devastating complication of severe hyperbilirubinemia.

• #66

  https://www.nhs.uk/conditions/jaundice-newborn/treatment/

  Phototherapy is treatment with a special type of light (not sunlight). […] It’s sometimes used to treat newborn jaundice by making it easier for your baby’s liver to break down and remove the bilirubin from your baby’s blood. […] Phototherapy aims to expose your baby’s skin to as much light as possible. […] If your baby’s jaundice does not improve, intensified phototherapy may be offered. […] Treatment cannot be stopped for breaks during intensified phototherapy, so you will not be able to breastfeed or hold your baby. […] Phototherapy is generally very effective for newborn jaundice and has few side effects. […] If your baby has a very high level of bilirubin in their blood or phototherapy has not been effective, they may need a complete blood transfusion, known as an exchange transfusion.

• #67 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  Total SBR level should be used to determine management decisions in cases of predominantly unconjugated hyperbilirubinaemia. […] Serum albumin level does not need to be measured in addition to the bilirubin to determine management. […] Sunlight exposure is no longer recommended as a treatment for jaundice due to risk of sunburn or overheating. […] Primary prevention of jaundice involves early and frequent breastfeeding (8-12 times per day for the first few days). […] Secondary prevention of jaundice involves the following: Perform a blood group, Rh (D) type and Coombs’ test on the infant’s (cord) blood if the mother is known to have a negative blood group or has not had antenatal blood grouping. […] Monitor all infants routinely for jaundice at least 12-hourly. […] Phototherapy should only be used when the bilirubin is approaching a concentration, which would usually lead to an exchange transfusion.

• #68 Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/neonates-hyperbilirubinemia-jaundice-clinical-pathway

  Infants 35 Weeks Gestation with Hyperbilirubinemia/Jaundice Summary of Changes AAP 2022 Guidance […] Visual jaundice assessment q12 hrs after delivery […] Measure TCB or TSB 24-48 hrs after birth or prior to discharge […] Phototherapy based on TSB, risk factor […] Discharge plan, follow-up, Rebound Testing […] Measure TcB or TSB […] Obtain TSB if: […] TcB level within 3 mg/dL of Phototherapy Threshold […] TcB 15 mg/dL […] Determine the time of bilirubin recheck […] Refer to ED as indicated […] Measure TSB, apply biliblanket […] Admit or discharge with a follow-up plan […] Use TSB to guide the decision to initiate phototherapy […] Discontinue when TSB is 2 mg/dL below the hour-specific threshold used to initiate Phototherapy, not current hour-of-life threshold […] Monitor TSB after Discontinuing Phototherapy […] Discharge Plan and Follow-up Care.

• #69 Hyperbilirubinemia in the Term Newborn | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html

  Hyperbilirubinemia is one of the most common problems encountered in term newborns. […] Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. […] The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity. […] Jaundice typically results from the deposition of unconjugated bilirubin pigment in the skin and mucus membranes. […] Unconjugated hyperbilirubinemia, the primary focus of this article, is the most common form of jaundice encountered by family physicians. […] Infants with risk factors should be monitored closely during the first days to weeks of life.

• #70 Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/neonates-hyperbilirubinemia-jaundice-clinical-pathway

  Infants 35 Weeks Gestation with Hyperbilirubinemia/Jaundice Summary of Changes AAP 2022 Guidance […] Visual jaundice assessment q12 hrs after delivery […] Measure TCB or TSB 24-48 hrs after birth or prior to discharge […] Phototherapy based on TSB, risk factor […] Discharge plan, follow-up, Rebound Testing […] Measure TcB or TSB […] Obtain TSB if: […] TcB level within 3 mg/dL of Phototherapy Threshold […] TcB 15 mg/dL […] Determine the time of bilirubin recheck […] Refer to ED as indicated […] Measure TSB, apply biliblanket […] Admit or discharge with a follow-up plan […] Use TSB to guide the decision to initiate phototherapy […] Discontinue when TSB is 2 mg/dL below the hour-specific threshold used to initiate Phototherapy, not current hour-of-life threshold […] Monitor TSB after Discontinuing Phototherapy […] Discharge Plan and Follow-up Care.

• #71 Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/neonates-hyperbilirubinemia-jaundice-clinical-pathway

  Infants 35 Weeks Gestation with Hyperbilirubinemia/Jaundice Summary of Changes AAP 2022 Guidance […] Visual jaundice assessment q12 hrs after delivery […] Measure TCB or TSB 24-48 hrs after birth or prior to discharge […] Phototherapy based on TSB, risk factor […] Discharge plan, follow-up, Rebound Testing […] Measure TcB or TSB […] Obtain TSB if: […] Refer to ED as indicated […] Measure TSB, apply biliblanket […] Admit or discharge with a follow-up plan […] Discontinue when TSB is 2 mg/dL below the hour-specific threshold used to initiate Phototherapy, not current hour-of-life threshold […] Monitor TSB after Discontinuing Phototherapy.

• #72 Neonatal jaundice – MedCrave online

  https://medcraveonline.com/NCOAJ/neonatal-jaundice.html

  yellow discoloration of the skin and the mucosa is caused by accumulation of excess of bilirubin in the tissue and plasma (serum bilirubin level should be in excess 7mg/dl. 30-50% of term newborn and more of preterm newborns develop clinical jaundice.1 […] The goal of treatment of physiologic jaundice is to prevent the level of serum bilirubin from rising. Two type of therapy can be used for infants with physiologic jaundice; phototherapy and exchange transfusion. […] the main form of therapy for infants with physiologic jaundice is phototherapy, the use of intense fluorescent light on the infant exposed skin it is belived that this light in the blue range acts to decompose bilirubin by the process of photo oxidation, phototherapy is effective in preventing or reducing an increase in bilirubin levels.

• #73 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  All infants receiving phototherapy must have a serum bilirubin level measured as well as basic investigations to exclude the common causes of unconjugated hyperbilirubinemia. […] The commencement of phototherapy necessitates further investigation for a cause. […] Treatment for jaundice includes: treatment of the cause (such as infection or hypothyroidism), adequate enteral hydration may reduce enterohepatic circulation of bilirubin, phototherapy, exchange transfusion. […] Exposure of jaundiced skin to light photo-isomerises the bilirubin molecule into forms which can be excreted directly into the bile, without having to be conjugated. […] The effectiveness of phototherapy increases with blue light (460-490 nm) and intensity of the light. […] The major drawback with phototherapy is that its effect is slow.

• #74 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  Provide lactation/feeding support to breastfeeding mothers whose baby is visibly jaundiced. […] Use the bilirubin level to determine the management of hyperbilirubinaemia in all babies (see the threshold table and the treatment threshold graphs). […] Do not use the albumin/bilirubin ratio when making decisions about the management of hyperbilirubinaemia. […] Do not subtract conjugated bilirubin from total serum bilirubin when making decisions about the management of hyperbilirubinaemia (see management thresholds in the threshold table and the treatment threshold graphs). […] During phototherapy: repeat serum bilirubin measurement 46 hours after initiating phototherapy […] repeat serum bilirubin measurement every 612 hours when the serum bilirubin level is stable or falling. […] Stop phototherapy once serum bilirubin has fallen to a level at least 50 micromol/litre below the phototherapy threshold.

• #75 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  All infants receiving phototherapy must have a serum bilirubin level measured as well as basic investigations to exclude the common causes of unconjugated hyperbilirubinemia. […] The commencement of phototherapy necessitates further investigation for a cause. […] Treatment for jaundice includes: treatment of the cause (such as infection or hypothyroidism), adequate enteral hydration may reduce enterohepatic circulation of bilirubin, phototherapy, exchange transfusion. […] Exposure of jaundiced skin to light photo-isomerises the bilirubin molecule into forms which can be excreted directly into the bile, without having to be conjugated. […] The effectiveness of phototherapy increases with blue light (460-490 nm) and intensity of the light. […] The major drawback with phototherapy is that its effect is slow.

• #76 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  Provide lactation/feeding support to breastfeeding mothers whose baby is visibly jaundiced. […] Use the bilirubin level to determine the management of hyperbilirubinaemia in all babies (see the threshold table and the treatment threshold graphs). […] Do not use the albumin/bilirubin ratio when making decisions about the management of hyperbilirubinaemia. […] Do not subtract conjugated bilirubin from total serum bilirubin when making decisions about the management of hyperbilirubinaemia (see management thresholds in the threshold table and the treatment threshold graphs). […] During phototherapy: repeat serum bilirubin measurement 46 hours after initiating phototherapy […] repeat serum bilirubin measurement every 612 hours when the serum bilirubin level is stable or falling. […] Stop phototherapy once serum bilirubin has fallen to a level at least 50 micromol/litre below the phototherapy threshold.

• #77 Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway | Children’s Hospital of Philadelphia

  https://pathways.chop.edu/clinical-pathway/neonates-hyperbilirubinemia-jaundice-clinical-pathway

  Infants 35 Weeks Gestation with Hyperbilirubinemia/Jaundice Summary of Changes AAP 2022 Guidance […] Visual jaundice assessment q12 hrs after delivery […] Measure TCB or TSB 24-48 hrs after birth or prior to discharge […] Phototherapy based on TSB, risk factor […] Discharge plan, follow-up, Rebound Testing […] Measure TcB or TSB […] Obtain TSB if: […] Refer to ED as indicated […] Measure TSB, apply biliblanket […] Admit or discharge with a follow-up plan […] Discontinue when TSB is 2 mg/dL below the hour-specific threshold used to initiate Phototherapy, not current hour-of-life threshold […] Monitor TSB after Discontinuing Phototherapy.

• #78 Patient education: Jaundice in newborn infants (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics

  Babies whose bilirubin levels increase to toxic levels despite other treatments, or who have signs of or are at significant risk for brain damage, may need something called „emergency exchange transfusion.” […] Preventing severe hyperbilirubinemia is important to avoid serious life-long complications. […] Experts recommend that all newborns, regardless of age, have their bilirubin levels tested before going home from the hospital. […] Timely identification and treatment are important to prevent serious complications of hyperbilirubinemia.

• #79 Hyperbilirubinemia in Pediatrics Nursing CEU – Nursing CE Central

  https://nursingcecentral.com/lessons/hyperbilirubinemia-in-pediatrics/

  In infants with hyperbilirubinemia, it is vital to promote nutrition and hydration. […] This is especially important for infants undergoing phototherapy. […] It is important to ensure that during phototherapy, infants continue feedings by breast or bottle. […] Because of the risk for excessive fluid loss, nurses should closely monitor: Dose of phototherapy (irradiance), Infants temperature, Hydration status (Intake and output), Time of exposure, Daily TSB levels. […] An exchange transfusion (ET) is a high-risk procedure that involves removing and replacing blood at a slow rate to lower the presence of bilirubin rapidly. […] However, exchange transfusions are indicated to treat symptomatic infants with clinical signs of moderate to advanced signs of severe unconjugated hyperbilirubinemia or and when intensive phototherapy is ineffective.

• #80 Neonatal Jaundice | ACG

  https://gi.org/topics/neonatal-jaundice/

  If the unconjugated or indirect bilirubin level remains high or is increasing, the baby may need further treatment to decrease the bilirubin level. Treatments might include: […] Phototherapy is a treatment that allows the bilirubin under the skin to be broken down by a special light that illuminates the baby’s body. These lights are usually blue-green. They are placed about 4 inches above the baby. The more skin that is exposed to the lights, the better they work to break down a larger amount of unconjugated or indirect bilirubin. The lights do not prevent the baby from drinking formula or being breast-fed. The baby can be safely removed from the phototherapy at feeding times without decreasing the efficacy of the treatment. […] For a few babies, the level of unconjugated or indirect bilirubin is so high (greater than 20-25 mg/dl) that physicians are concerned about brain damage. The level has to be brought down very fast using a technique called exchange transfusion. An exchange transfusion is performed in the neonatal intensive care unit. The baby’s blood is exchanged and replaced very slowly and carefully with a donor’s blood. This allows for the indirect bilirubin to be removed faster, which will decrease the risk of further complications. This treatment is reserved for the most serious cases at risk for developing kernicterus (a condition where the indirect bilirubin is stored in areas of the brain and causes abnormal movements and seizures.)

• #81 Jaundice in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/jaundice-in-neonates

  Visual estimations of the bilirubin level or estimation by transcutaneous monitor in infants undergoing phototherapy are not reliable. […] Exchange transfusion should be considered in infants with Rh disease who have not received blood transfusions in utero. […] Indications for exchange transfusion in well, term infants are: bilirubin >340 micromol/L, likely to exceed that concentration for any length of time.

• #82 Neonatal jaundice – Wikipedia

  https://en.wikipedia.org/wiki/Neonatal_jaundice

  Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Other symptoms may include excess sleepiness or poor feeding. Complications may include seizures, cerebral palsy, or kernicterus. […] The need for treatment depends on bilirubin levels, the age of the child, and the underlying cause. Treatments may include more frequent feeding, phototherapy, or exchange transfusions. […] Phototherapy is the main treatment of neonatal jaundice. Babies with neonatal jaundice may be treated with colored light called phototherapy, which works by changing trans-bilirubin into the water-soluble cis-bilirubin isomer. […] Recent studies from several countries show that phototherapy can safely and effectively be performed in the family’s home, and since 2022 home phototherapy is recommended as an alternative to readmission to hospital in the American national guidelines. […] Exchange transfusions performed to lower high bilirubin levels are an aggressive treatment.

• #83 Neonatal Jaundice Treatment & Management: Approach Considerations, Medical Care, Phototherapy

  https://emedicine.medscape.com/article/974786-treatment

  Surgical care is not indicated in infants with physiologic neonatal jaundice. However, operative intervention is indicated in infants whose jaundice is caused by bowel or external bile duct atresia. […] For infants with physiologic neonatal jaundice, no consultation is required. Consult gastroenterologists and surgeons regarding infants with jaundice resulting from hepatobiliary or bowel disease. […] Infants in need of exchange transfusion who are born at or admitted to facilities not capable of performing this procedure should be transferred to the nearest facility with such capability. In addition to complete records, the infant should be accompanied by a sample of maternal blood which is needed by the blood bank to match blood. […] If the infant is in imminent danger of kernicterus, or is already exhibiting signs of neurologic compromise, immediately initiate the most efficient phototherapy possible under the circumstances, and continue it until transfer commences.

• #84 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Jaundice Nursing Care Plans and Nursing Diagnosis […] Hyperbilirubinemia is the elevation of serum bilirubin levels that is related to the hemolysis of RBCs and subsequent reabsorption of unconjugated bilirubin from the small intestines. The condition may be benign or place the neonate at risk for multiple complications/untoward effects. […] The newborns liver is immature, which contributes to icterus, or jaundice. The liver cannot clear the blood of bile pigments that result from the normal postnatal destruction of red blood cells. The higher the blood bilirubin level is, the deeper jaundice and the greater risk for neurological damage. Physiological jaundice is normal, while pathological jaundice is more serious, which occurs within 24 hours of birth, and is secondary to an abnormal condition, such ABO-Rh incompatibility. The normal rise in bilirubin levels in preterm infants is slower than in full-term infants. It lasts longer, which predisposes the infant to hyperbilirubinemia or excessive bilirubin levels in the blood. […] Physiological jaundice is the most common type of newborn hyperbilirubinemia. This unconjugated hyperbilirubinemia presents in newborns after 24 hours of life and can last up to the first week. Pathological jaundice is defined as the appearance of jaundice in the first 24 hours of life due to an increase in serum bilirubin levels greater than 5 mg/dl/day, conjugated bilirubin levels 20% of total serum bilirubin, peak levels higher than the normal range, and the presence of clinical jaundice greater than two weeks. Breast milk jaundice occurs in breastfed newborns between the first and third day of life but peaks by day 5 to 15, with a decline occurring by the third week of life (Morrison, 2021).

• #85 Infant jaundice – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-jaundice/symptoms-causes/syc-20373865

  Infant jaundice is yellow discoloration of a newborn baby’s skin and eyes. Infant jaundice occurs because the baby’s blood contains an excess of bilirubin (bil-ih-ROO-bin), a yellow pigment of red blood cells. […] Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream. In some babies, an underlying disease may cause infant jaundice. […] Most infants born between 35 weeks’ gestation and full term need no treatment for jaundice. Rarely, an unusually high blood level of bilirubin can place a newborn at risk of brain damage, particularly in the presence of certain risk factors for severe jaundice.

• #86 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Discuss home management of mild or moderate physiological jaundice, including increased feedings, diffused exposure to sunlight (checking infant frequently), and a follow-up serum testing program. […] Provide information about maintaining milk supply through a breast pump and reinstating breastfeeding when jaundice necessitates interruption of breastfeeding. This helps mothers maintain adequate milk supply to meet the infants needs when breastfeeding is resumed. Infants weighing more than 1500 g (3.3 lb) may be able to bottle feed if a small, soft nipple with a large hole is used to minimize the energy and effort required for sucking. Breast milk may be manually expressed by the mother and placed in a bottle for her preterm infant. […] Discuss the need for Rh immune globulin (RhIg) within 72 hours following delivery for an Rh-negative mother with an Rh-positive infant who has not been previously sensitized. Rh-Ig may minimize the incidence of maternal isoimmunization in non-sensitized mothers and may help to prevent erythroblastosis fetalis in subsequent pregnancies. […] Provide appropriate referral for a home phototherapy program, if necessary. The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program.

• #87 Neonatal Jaundice | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23803

  All newborns should undergo an appropriate evaluation for possible jaundice before hospital discharge. […] Phototherapy (PT) remains the first-line treatment for managing pathologic unconjugated hyperbilirubinemia. […] Phototherapy is considered safe, but recent evidence suggests a possible association with long-term sequelae, including a small risk of epilepsy. […] Intravenous immunoglobulin (IVIG) is used when immune-mediated hemolysis is the cause of unconjugated hyperbilirubinemia, which prevents RBC hemolysis by coating Fc receptors on RBCs. […] The prognosis for conjugated hyperbilirubinemia depends on the etiology. […] The prognosis of patients with biliary atresia is significantly improved by early diagnosis and surgery within 60 days of life. […] Most cases are self-limiting with an excellent prognosis. […] However, bilirubin encephalopathy is an uncommon but devastating complication of severe hyperbilirubinemia.

• #88 Neonatal Jaundice Treatment & Management: Approach Considerations, Medical Care, Phototherapy

  https://emedicine.medscape.com/article/974786-treatment

  If the hyperbilirubinemia is due to blood group isoimmunization, immediately start an infusion of intravenous immunoglobulin (IVIG) at 500 mg/kg, and continue it before and during transfer until completed (2 hours). […] Phototherapy, IVIG, and exchange transfusion are the most widely used therapeutic modalities in infants with neonatal jaundice. […] Phototherapy is the primary treatment in neonates with unconjugated hyperbilirubinemia. […] Phototherapy can be administered in a number of ways. […] Key points in the practical execution of phototherapy include maximizing energy delivery and the available surface area. […] The infant should be naked except for diapers (use these only if deemed absolutely necessary and cut them to the minimum workable size), and the eyes should be covered to reduce risk of retinal damage.

• #89 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Discuss home management of mild or moderate physiological jaundice, including increased feedings, diffused exposure to sunlight (checking infant frequently), and a follow-up serum testing program. […] Provide information about maintaining milk supply through a breast pump and reinstating breastfeeding when jaundice necessitates interruption of breastfeeding. This helps mothers maintain adequate milk supply to meet the infants needs when breastfeeding is resumed. Infants weighing more than 1500 g (3.3 lb) may be able to bottle feed if a small, soft nipple with a large hole is used to minimize the energy and effort required for sucking. Breast milk may be manually expressed by the mother and placed in a bottle for her preterm infant. […] Discuss the need for Rh immune globulin (RhIg) within 72 hours following delivery for an Rh-negative mother with an Rh-positive infant who has not been previously sensitized. Rh-Ig may minimize the incidence of maternal isoimmunization in non-sensitized mothers and may help to prevent erythroblastosis fetalis in subsequent pregnancies. […] Provide appropriate referral for a home phototherapy program, if necessary. The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program.

• #90 Recommendations | Jaundice in newborn babies under 28 days | Guidance | NICE

  https://www.nice.org.uk/guidance/cg98/chapter/recommendations

  a rapidly rising bilirubin level of greater than 8.5 micromol/litre per hour. […] In babies with a gestational age of 37 weeks or more with jaundice lasting more than 14 days, and in babies with a gestational age of less than 37 weeks and jaundice lasting more than 21 days: look for pale chalky stools and/or dark urine that stains the nappy […] measure the conjugated bilirubin […] follow expert advice about care for babies with a conjugated bilirubin level greater than 25 micromol/litre because this may indicate serious liver disease. […] Use intravenous immunoglobulin (IVIG) (500 mg/kg over 4 hours) as an adjunct to continuous intensified phototherapy in cases of rhesus haemolytic disease or ABO haemolytic disease when the serum bilirubin continues to rise by more than 8.5 micromol/litre per hour.

• #91 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  Discuss home management of mild or moderate physiological jaundice, including increased feedings, diffused exposure to sunlight (checking infant frequently), and a follow-up serum testing program. […] Provide information about maintaining milk supply through a breast pump and reinstating breastfeeding when jaundice necessitates interruption of breastfeeding. This helps mothers maintain adequate milk supply to meet the infants needs when breastfeeding is resumed. Infants weighing more than 1500 g (3.3 lb) may be able to bottle feed if a small, soft nipple with a large hole is used to minimize the energy and effort required for sucking. Breast milk may be manually expressed by the mother and placed in a bottle for her preterm infant. […] Discuss the need for Rh immune globulin (RhIg) within 72 hours following delivery for an Rh-negative mother with an Rh-positive infant who has not been previously sensitized. Rh-Ig may minimize the incidence of maternal isoimmunization in non-sensitized mothers and may help to prevent erythroblastosis fetalis in subsequent pregnancies. […] Provide appropriate referral for a home phototherapy program, if necessary. The lack of available support systems and education may necessitate visiting nurses to monitor the home phototherapy program. Home phototherapy programs are being used for newborns with mild to moderate physiological jaundice. The infants pediatrician makes a referral for home care based on the newborns health, bilirubin levels (generally between 10 to 14 mg/dL), evidence of jaundice, and the familys suitability for complying with the home program.

• #92 Care of Newborn with Hyperbilirubinemia: A Parent’s Guide

  https://lanalifecare.com/care-of-newborn-with-hyperbilirubinemia/

  Make sure to breastfeed your baby regularly and adequately, along with providing him with appropriate supplements. This will greatly help him overcome high bilirubin in the blood, as it will enable the body to get rid of it. […] Placing the baby under a lamp that emits blue-green spectrum rays helps break down bilirubin and convert it into smaller compounds that can be easily excreted from the body in urine and stool, but it requires advanced Newborn Baby care to protect the baby from any side effects of direct light. […] The care of newborn with hyperbilirubinemia here involves transferring the newborn to the NICU, withdrawing small amounts of the babys blood at intervals, and replacing it with a donor blood sample to reduce the bilirubin and antibodies that reach the newborn from the mother.

• #93 A Practical Approach to Neonatal Jaundice | AAFP

  https://www.aafp.org/pubs/afp/issues/2008/0501/p1255.html

  Physicians should encourage optimal breastfeeding (eight to 12 feedings per day) to decrease the incidence of hyperbilirubinemia. Physicians should liberally screen all infants for jaundice and risk factors. Bilirubin levels should be interpreted according to the infant’s age in hours. […] The key to secondary prevention is vigilance on the part of the health care team. All hospitalized newborns should be routinely monitored by nursing staff and physicians for the development of jaundice every eight to 12 hours, including at the time that vital signs are taken. Measurement and interpretation of the predischarge bilirubin level can help determine the timing of outpatient follow-up evaluations. […] Newborns should be examined within 24 to 72 hours of hospital discharge to assess for jaundice and general well-being. An infant should be seen by the age of 72 hours if discharged before 24 hours; by the age of 96 hours if discharged between 24 and 47.9 hours; and by the age of 120 hours if discharged between 48 and 72 hours. Earlier follow-up (within 24 to 48 hours) should be instituted for infants with more risk factors for severe hyperbilirubinemia, shorter hospital stays, or predischarge bilirubin levels in the high-intermediate or high-risk zones.

• #94 Newborn jaundice – discharge – UF Health

  https://ufhealth.org/care-sheets/newborn-jaundice-discharge

  Your baby has newborn jaundice. This common condition is caused by high levels of bilirubin in the blood. Your child’s skin and sclera (whites of their eyes) will look yellow. […] To help break down the bilirubin, your child will be placed under bright lights (phototherapy) in a warm, enclosed bed. The infant will wear only a diaper and special eye shades. Your baby may have an intravenous (IV) line to give them fluids. […] Unless there are other problems, your child will be able to feed (by breast or bottle) normally. Your child should feed every 2 to 2 hours (10 to 12 times a day). […] You must keep the light therapy on your child’s skin and feed your child every 2 to 3 hours (10 to 12 times a day). Feeding prevents dehydration and helps bilirubin leave the body. […] Therapy will continue until your baby’s bilirubin level lowers enough to be safe. Your baby’s provider will want to check the level again in 2 to 3 days.

• #95 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Assess infant for skin abnormalities; note color (yellowing) of skin or eyes. […] Yellowing of the skin can be determined by lightly pressing on the skin of a babys forehead. This is the most common indicator of neonatal jaundice. […] Assess infant for neurological involvement. […] Infant will likely be very fussy when awake, and difficult to awaken from sleep. Many mothers inadvertently delay waking the baby to feed. […] More advanced stages include hyperreflexia (twitching, over-excitability, sensitive reflexes, and convulsions). […] A stressful delivery, including the use of assistive devices such as forceps or vacuum, can increase the risk of neonatal jaundice. […] Transcutaneous method is preferred due to non-invasive nature of test. Levels greater than 12 mg/dL usually require treatment;

• #96 Jaundice in newborns | Caring for kids

  https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/jaundice_in_newborns

  Phototherapy is safe. Your babys eyes will be protected with special eye patches. […] Jaundice can be more serious for babies: born before 37 weeks, who weigh less than 2500 grams (5.5 lbs.) at birth, whose blood group is incompatible with their mothers blood group, who develop jaundice early in life, especially during the first 24 hours, whose jaundice has moved to the arms and legs, who have a lot of bruising or swelling under the scalp (called caput) after birth, whose siblings had jaundice at birth and needed treatment with an exchange transfusion (babys blood is removed and replaced). […] Call your doctor if your baby shows any of the following symptoms: refuses breastfeeding or bottle feeding, is very sleepy all the time, has lost a lot of weight (more than 10% of their weight at birth), is extremely jaundiced (arms and legs are a yellow or orange colour), or jaundice that seems to be getting worse.

• #97 Newborn jaundice – discharge – UF Health

  https://ufhealth.org/care-sheets/newborn-jaundice-discharge

  Contact your baby’s health care provider if the infant: […] Has a yellow color that goes away, but then returns after treatment stop […] Has a yellow color that lasts for more than 2 to 3 weeks. […] Also contact your baby’s provider if you have concerns, if the jaundice is getting worse, or the baby: […] Is lethargic (hard to wake up), less responsive, or fussy […] Refuses the bottle or breast for more than 2 feedings in a row […] Is losing weight […] Has watery diarrhea.

• #98 Jaundice in Healthy Newborns – La Leche League GB

  https://laleche.org.uk/jaundice/

  If your new baby has jaundice, its normal to be worried and concerned. Knowing more about newborn jaundice will help you decide if you need to see medical help and understand why tests may be needed. […] More than 80% of all newborns appear jaundiced during the first week of life. In most cases, this is a normal part of adjusting to life outside the womb, but occasionally jaundice is a sign of other more serious health problems. Jaundice is also more common in pre-term and premature babies, who need treatment to avoid serious health problems. Sometimes treatment of jaundice presents challenges that new breastfeeding mothers and their babies need to overcome. […] Seek medical help if your baby: appears jaundiced within 48 hours of birth; appears jaundiced beyond the third week; appears jaundiced and is premature or sick; shows yellowing of the palms of the hands or the soles of the feet; has black, brown or green poo after day 5; shows signs of dehydration with fewer than five wet nappies per day.

• #99 Hyperbilirubinemia in Pediatrics Nursing CEU – Nursing CE Central

  https://nursingcecentral.com/lessons/hyperbilirubinemia-in-pediatrics/

  In addition to closely monitoring feedings, it is important for the nurse to closely monitor urine and stool output. […] This is important to ensure that the infant is properly excreting waste and hydrating. […] Treating hyperbilirubinemia in the newborn includes the following interventions: Adequate nutrition, Phototherapy, Exchange transfusion. […] Phototherapy is the most common intervention used to treat jaundice and hyperbilirubinemia of the newborn. […] The key benefit to phototherapy is reducing TSB levels and preventing TSB levels from rising to a level in which an exchange transfusion is indicated. […] Nurses should be mindful of ways to maximize the benefits of phototherapy. […] It is important to: Place infant supine. Maximize skin exposure size down on diaper. Cover infants eyes with an eye shield. Monitor the infant during therapy. If applicable, time spent off phototherapy for feeds. Limit to 30 minutes or less.

• #100 Neonatal jaundice – MedCrave online

  https://medcraveonline.com/NCOAJ/neonatal-jaundice.html

  Assess fluid volume status of child by intake and output chart […] Providing proper intravenous fluid to child […] Providing proper fluid to child […] Maintaining intake and output chart […] Assess the skin integrity of child […] Providing proper care to child […] Changing position every hourly to prevent skin breakdown […] Apply powder to skin and back care to prevent skin integrity […] Applying emollient cream to child skin […] Assess the body temperature of child by thermometer […] Providing cold compress to child […] Providing tepid sponge to child […] Maintain proper ventilation in ward […] Providing antipyretic as per physician order […] Assess the knowledge of parents by asking question […] Providing psychological support to parents […] Explain regarding hospital rules and regulation […] Explain about treatment of child to parents […] Providing diversional therapy to child and parents e.g.: books, music, TV.

• #101

  https://step2.medbullets.com/pediatrics/120596/neonatal-jaundice

  Medical management: no treatment indicated in physiologic jaundice. […] Phototherapy indicated when bilirubin levels 15-20 mg/dl regardless of cause. […] Exchange transfusion may be indicated in very severe cases of hyperbilirubinemia. […] Complications: Retinal damage, dehydration, dermatitis, and diarrhea all related to UV exposure. […] Prognosis: Ranges widely. Can spontaneously resolve or be fatal depending on etiology.

• #102

  https://www.nhs.uk/conditions/jaundice-newborn/

  Treatment is usually only recommended if tests show very high levels of bilirubin in a baby’s blood. […] There are 2 main treatments that can be carried out in hospital to quickly reduce your baby’s bilirubin levels. […] If a baby with very high levels of bilirubin is not treated, there’s a risk they could develop permanent brain damage. This is known as kernicterus.

• #103 Patient education: Jaundice in newborn infants (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/jaundice-in-newborn-infants-beyond-the-basics/print

  The goal of treating jaundice is to efficiently and safely reduce the level of bilirubin in the blood before it becomes toxic. […] Phototherapy — Phototherapy is the most common medical treatment for hyperbilirubinemia in babies. […] Phototherapy is usually given in a hospital. […] Breastfeeding during phototherapy — It is important for babies receiving phototherapy to drink adequate fluids (ideally breast milk) since bilirubin is eliminated in urine and stool. […] Babies who are not able to drink enough breast milk lose more weight than expected during the first week. […] Exchange transfusion — Babies whose bilirubin levels increase to toxic levels despite other treatments, or who have signs of or are at significant risk for brain damage, may need something called „emergency exchange transfusion.”

• #104 Newborn Jaundice | American Pregnancy Association

  https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/newborn-jaundice/

  The symptoms of jaundice include yellowing of the skin and yellowing of the eyes. Some times in severe cases of jaundice, a baby will seem very sleepy and have a hard time feeding. […] If jaundice is left untreated and bilirubin levels reach limits exceeding 25mg, there is the possibility of cerebral palsy, deafness, or certain forms of brain damage to occur. […] In most full-term, healthy babies, jaundice will resolve on its own and no treatment other than frequent feedings will be necessary. But, dependent on the levels of bilirubin in the baby’s blood, and the age of the baby, a more aggressive approach to treatment may be needed. Treatment for jaundice includes frequent feedings to encourage frequent bowel moments. Bowel movements help to eliminate the bilirubin out of the body. Phototherapy is a light that helps break down the bilirubin in the baby’s skin. In severe cases of jaundice, a blood transfusion or blood exchange may be needed.

• #105 Hyperbilirubinemia in the Newborn – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=hyperbilirubinemia-in-the-newborn-90-P02375

  High levels of bilirubin can travel to your babys brain. This can cause seizures and brain damage. This is called kernicterus. […] This condition cant really be prevented except in the case of breastfeeding failure jaundice. Feedings should start within the first hour of life and continue at least every 2 or 3 hours, or sooner if the baby shows signs of wanting to eat.

• #106 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Evaluate parents understanding of the care plan, including the importance of phototherapy, feeding practices, and signs of worsening jaundice. Address any misconceptions and provide additional education if needed. […] Convene with the healthcare team to review the overall progress of the newborn. Discuss any challenges encountered during the implementation phase, make adjustments to the care plan as necessary, and ensure continued collaboration among team members.

• #107 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

  https://nurseslabs.com/hyperbilirubinemia-nursing-care-plans/

  The nursing care plan for clients with hyperbilirubinemia involves preventing injury/progression of the condition, providing support/appropriate information to family, maintaining physiological homeostasis with bilirubin levels declining, and preventing complications. […] The following are the nursing priorities for patients with hyperbilirubinemia (jaundice): Bilirubin level monitoring. Regularly monitoring the bilirubin levels in the patients blood to assess the severity of hyperbilirubinemia. Identification of underlying cause. Investigating and identifying the underlying cause of hyperbilirubinemia to guide treatment decisions. Phototherapy. Initiating and managing phototherapy to help break down bilirubin and reduce its levels in the blood. Blood transfusion. Considering blood transfusion in severe cases of hyperbilirubinemia to remove excess bilirubin and provide additional red blood cells. Neonatal assessment. Conducting a thorough neonatal assessment to evaluate the overall health and identify any additional concerns associated with hyperbilirubinemia. Parent education. Educating parents about the causes, management, and signs of worsening hyperbilirubinemia, as well as the importance of follow-up care. Liver function evaluation. Assessing liver function to determine if there are any underlying liver disorders contributing to hyperbilirubinemia. Coordinating with pediatric specialists. Collaborating with pediatricians and specialists to ensure comprehensive care and appropriate management of hyperbilirubinemia. Support for breastfeeding. Providing guidance and support to breastfeeding mothers to optimize feeding practices, which can help with bilirubin elimination. Long-term follow-up. Planning for long-term follow-up to monitor the resolution of hyperbilirubinemia and identify any potential long-term effects or complications.

• #108 Nursing Care Plan (NCP) for Neonatal Jaundice | Hyperbilirubinemia | Free NURSING.com Courses

  https://nursing.com/lesson/nursing-care-plan-for-hyperbilirubinemia-of-the-newborn-infant-jaundice-neonatal-hyperbilirubinemia

  Communication and Education: Develop effective communication skills to educate parents about the causes, signs, and management of neonatal hyperbilirubinemia. Provide support and guidance for parents in caring for their jaundiced newborns at home. […] The primary goal is to reduce and maintain bilirubin levels within the normal range for the infants age, minimizing the risk of bilirubin-induced neurotoxicity. […] Achieve the resolution of jaundice, ensuring that the yellow discoloration of the skin and sclera diminishes as bilirubin levels decrease. […] Regular monitoring for potential complications, such as kernicterus or acute bilirubin encephalopathy, and promptly addressing any signs or symptoms to prevent long-term neurological damage. […] Provide thorough education to parents or caregivers regarding the importance of monitoring feeding, promoting adequate hydration, and recognizing signs of worsening jaundice. This empowers parents to actively participate in the care of their newborn.

• #109 Neonatal Jaundice Management

  https://ceufast.com/course/neonatal-jaundice-management

  Pathologic UHB occurs much more rarely, often presents within the first 24 hours of life, and increases rapidly. […] For full term, healthy neonates over 24 hours of age and determined to be exhibiting non-pathologic jaundice, management can safely take place in the outpatient setting. […] Phototherapy uses blue-green light waves to alter bilirubin molecules and make them water-soluble and ready for excretion without needing to be conjugated in the hepatic system. […] For infants suspected of exhibiting pathologic jaundice, close hospital management with neonatology is indicated. […] If bilirubin levels start to approach those associated with kernicterus despite phototherapy, exchange transfusion may be necessary to protect the jaundiced infant’s CNS status. […] With prompt identification and treatment, UHB is extremely treatable, and prognosis is excellent. […] A solid foundation of knowledge for how to identify and manage neonatal hyperbilirubinemia is necessary for any nurse working in a maternal-newborn or pediatric setting.

• #110 Neonatal Jaundice | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/23803

  All newborns should undergo an appropriate evaluation for possible jaundice before hospital discharge. […] Phototherapy (PT) remains the first-line treatment for managing pathologic unconjugated hyperbilirubinemia. […] Phototherapy is considered safe, but recent evidence suggests a possible association with long-term sequelae, including a small risk of epilepsy. […] Intravenous immunoglobulin (IVIG) is used when immune-mediated hemolysis is the cause of unconjugated hyperbilirubinemia, which prevents RBC hemolysis by coating Fc receptors on RBCs. […] The prognosis for conjugated hyperbilirubinemia depends on the etiology. […] The prognosis of patients with biliary atresia is significantly improved by early diagnosis and surgery within 60 days of life. […] Most cases are self-limiting with an excellent prognosis. […] However, bilirubin encephalopathy is an uncommon but devastating complication of severe hyperbilirubinemia.

Zobacz więcej