Materiały źródłowe

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

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

  Jaundice in newborns is the yellow coloring in an infants skin. Jaundice occurs when bilirubin (pronounced bil-ih-ROO-bin) builds up in your babys blood. Hyperbilirubinemia is the medical term for this condition. […] Jaundice in infants is common. Its usually not serious and goes away within a couple of weeks. But its important for your babys healthcare provider to check them for jaundice. Severe jaundice can lead to brain damage if it goes untreated. […] Your babys healthcare provider will check for signs of jaundice while youre still in the hospital. Your babys bilirubin level will be highest when theyre three to five days old. Its important that your babys healthcare provider checks them again within this time frame. […] The American Academy of Pediatrics uses a newborn jaundice level chart to determine if a baby needs treatment. The chart is based on your babys total serum bilirubin level and age.

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

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

  Treatment for jaundice in newborns isnt usually necessary. Mild levels of jaundice typically go away on their own as your babys liver continues to develop. This can take one to two weeks. […] If your babys bilirubin level is high or continues to rise, their healthcare provider may recommend phototherapy treatment. […] Jaundice in newborns is normal and usually cant be prevented. You can reduce the risk that your baby will develop severe jaundice by feeding them often. […] Jaundice in newborns is common. For most babies, jaundice will get better without treatment within one to two weeks. But its important to have your babys bilirubin level checked. A high bilirubin level can lead to serious health conditions if its not treated immediately. These conditions include cerebral palsy, deafness and kernicterus, a type of brain damage. […] Your babys healthcare provider should check your babys bilirubin level before you leave the hospital and again within five days of birth.

• #2 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. The two types of neonatal hyperbilirubinemia are unconjugated hyperbilirubinemia and conjugated hyperbilirubinemia. In most neonates, unconjugated hyperbilirubinemia is the cause of clinical jaundice. However, some infants have conjugated hyperbilirubinemia, which is always pathologic and signifies an underlying medical or surgical etiology. Failure to identify and treat pathologic jaundice may result in bilirubin encephalopathy and associated neurological sequelae.

• #3 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. […] In babies where jaundice levels are very high in the days after birth, treatment using blue lights (phototherapy) may be required. […] The underlying cause of jaundice in babies must be found. Some of the diagnostic tests may include: physical examination (always), skin reading of jaundice levels (often), blood tests (sometimes), ultrasound scan, liver biopsy or exploratory surgery (rarely). […] Treatment for jaundice in babies depends on the cause, but may include: mild jaundice if the baby is otherwise healthy and well, no treatment is necessary.

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

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

  Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. […] Most hospitals have a policy of examining babies for jaundice before discharge. The American Academy of Pediatrics recommends that newborns be examined for jaundice during routine medical checks and at least every eight to 12 hours while in the hospital. […] Your baby should be examined for jaundice between the third and seventh day after birth, when bilirubin levels usually peak. […] Excess bilirubin (hyperbilirubinemia) is the main cause of jaundice. […] A newborn’s immature liver often can’t remove bilirubin quickly enough, causing an excess of bilirubin. […] An underlying disorder may cause infant jaundice. […] Major risk factors for jaundice, particularly severe jaundice that can cause complications, include: Premature birth.

• #5 Newborn Jaundice: Causes, Symptoms, Treatment, and Prevention

  https://www.healthline.com/health/newborn-jaundice

  Newborn jaundice is when a babys skin and eyes turn yellow from too much bilirubin. […] Though distinct yellow coloring confirms that a baby has jaundice, additional tests may be needed to determine the severity. […] Babies who develop jaundice will get a bilirubin blood test to determine the levels of bilirubin in their blood. […] Additional tests may be needed to see if a babys jaundice is due to an underlying condition. This may include testing your baby for their complete blood count (CBC), blood type, and Rh incompatibility. […] Additionally, a Coombs test may be done to check for antibodies that show an elevated risk of increased red cell breakdown (hemolysis).

• #6 Detection of jaundice in newborn babies

  https://www.hssib.org.uk/patient-safety-investigations/detection-of-jaundice-in-newborn-babies/

  This report explored the detection and diagnosis of jaundice in newborn babies, in particular babies born prematurely (before 37 weeks of pregnancy). […] If left undiagnosed and untreated, high bilirubin levels in newborn babies can lead to significant harm. […] It is therefore important that jaundice is diagnosed and treated in a timely way. This relies on visual signs of jaundice being present and observed by clinical staff. […] The assessment of visual signs of jaundice in newborn babies is subjective and more challenging with babies who have black or brown skin. […] HSIB recommends that the National Institute for Health and Care Excellence reviews the available evidence and updates its guidance if appropriate, regarding: the reliability of visual signs to detect jaundice in newborn babies, particularly in babies with black and brown skin. […] HSIB recommends that the Royal College of Pathologists works with stakeholders to understand current practice and make any appropriate recommendations to promote the adoption of an icteric threshold at which a bilirubin test may be cascaded or reported.

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

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

  Jaundice in newborns is characterized by a yellowing of the skin and eyes due to high levels of bilirubin in the blood. […] 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. […] 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. […] 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.

• #8 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  Neonatal jaundice is usually noted clinically when serum bilirubin is 5 mg/dL. Occurs in 60% to 70% of term neonates. Most cases are physiologic. […] Jaundice in the first 24 hours of life is considered pathologic. […] Treatment for hyperbilirubinemia may include phototherapy and if more severe, exchange transfusion. […] The major complication of unconjugated hyperbilirubinemia is kernicterus. […] This topic focuses on recognizing and managing early neonatal jaundice, which is most commonly caused by unconjugated hyperbilirubinemia. […] Key diagnostic factors include presence of risk factors, cephalocaudal progression, decreasing gestational age, male, family history of jaundice, family history of anemia, family history of splenectomy, maternal exposure to sulfonamides or antimalarials, hepatosplenomegaly, microcephaly, chorioretinitis, small for gestational age, cephalhematoma, hypertonia, high-pitched cry, retrocollis, opisthotonus.

• #8 Neonatal jaundice – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/672

  1st tests to order include transcutaneous bilirubin (TcB), total serum bilirubin, direct Coombs test, direct serum bilirubin. […] Tests to consider include hematocrit, CBC, reticulocyte count, peripheral blood smear, blood groups, glucose-6-phosphate dehydrogenase (G6PD) screening, osmotic fragility test, blood culture, liver function tests, urine for reducing substances, plasma amino acids, urine organic acids, urine culture, abdominal ultrasound, percutaneous liver biopsy.

• #9 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. Tests to detect jaundice and measure bilirubin include: […] Your doctor may order additional blood tests or urine tests if there’s evidence that your baby’s jaundice is caused by an underlying disorder. […] When your baby is discharged from the hospital, your doctor or nurse will look for jaundice. If your baby has jaundice, your doctor will assess the likelihood of severe jaundice based on a number of factors: […] 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.

• #10 Neonatal Jaundice Workup: Laboratory Studies, Imaging Studies, Other Tests

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

  Bilirubin measurement may include the following: […] Total serum bilirubin measurement has long been the standard method for quantitating serum bilirubin levels. […] Transcutaneous bilirubinometry can be performed using handheld devices that incorporate sophisticated optical algorithms. […] Use of such devices has been shown to reduce the need for blood sampling in infants with jaundice. […] In infants with mild jaundice, transcutaneous bilirubinometry may be all that is needed to assure that total bilirubin levels are safely below those requiring intervention. […] In infants with moderate jaundice, transcutaneous bilirubinometry may be useful in selecting patients who require blood sampling for serum bilirubin measurement. […] In infants with extreme jaundice, transcutaneous bilirubinometry may be a useful tool to fast track such infants to rapid and aggressive therapy.

• #10 Neonatal Jaundice Workup: Laboratory Studies, Imaging Studies, Other Tests

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

  Infants in whom family, maternal, pregnancy, or case histories suggest the possibility of a pathologic process […] Infants in whom physical examination reveals findings not explained by simple physiologic hyperbilirubinemia. […] In addition to total serum bilirubin levels, other suggested studies may include the following, particularly if the rate of rise or the absolute bilirubin concentration is approaching the need for phototherapy: Blood type and Rh determination in mother and infant […] Direct antiglobulin test (DAT) in the infant (direct Coombs test) […] Nomogram for hour-specific bilirubin values: This is a useful tool for predicting, either before or at the time of hospital discharge, which infants are likely to develop high serum bilirubin values. […] Measurement of end-tidal carbon monoxide in breath (ETCO): ETCO may be used as an index of bilirubin production.

• #10 Neonatal Jaundice Workup: Laboratory Studies, Imaging Studies, Other Tests

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

  Liver function tests: Aspartate aminotransferase (ASAT or SGOT) and alanine aminotransferase (ALAT or SGPT) levels are elevated in hepatocellular disease. […] Tests for viral and/or parasitic infection: These may be indicated in infants with hepatosplenomegaly, petechiae, thrombocytopenia, or other evidence of hepatocellular disease. […] Auditory and visually evoked potentials are affected during ongoing significant jaundice; however, no criteria have been established that allow extrapolation from evoked potential findings to the risk of kernicterus. […] Brainstem auditory-evoked potentials should be obtained in the aftermath of severe neonatal jaundice to exclude sensorineural hearing loss. […] This distinction was not always clearly understood in older descriptions of so-called „low-bilirubin kernicterus.”

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

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

  Newborn jaundice is identified by visually examining the baby after birth. Testing for bilirubin levels in the blood or the skin confirms the presence of hyperbilirubinemia. […] The blood test involves collecting a small amount (less than one-quarter teaspoon) of blood from the baby. Results of blood testing are available in most hospitals within a few hours. […] In some hospitals, screening for high bilirubin is at first performed by a device that measures bilirubin levels in the skin (referred to as „transcutaneous” screening). Although transcutaneous measurement may closely estimate levels of bilirubin in the blood, it has some limitations and is not as sensitive as a blood test. Therefore, when the skin measurement exceeds a normal value, blood testing is done to make sure that the level of bilirubin is accurate. […] If a baby still has jaundice after one week of age, testing is also done to check bilirubin levels and rule out a serious condition (such as a liver condition that leads to delayed bilirubin removal).

• #12 Diagnosing and Treating Newborn Jaundice – VIA Global Health

  https://viaglobalhealth.com/buyers-guides/newborn-jaundice/diagnosing-and-treating-newborn-jaundice/

  Globally over 100,000 late-preterm and term babies die each year because of jaundice, a condition caused by hyperbilirubinemia, which is elevated bilirubin in the bloodstream. […] By understanding the diagnosis and management of jaundice, and products that can help support these important interventions, medical distributors can expand access to high-quality healthcare for newborns and their families, and prevent long-term complications and disabilities from jaundice. […] All infants at risk, or suspected of having elevated bilirubinemia, should have a laboratory test of serum bilirubin to diagnose jaundice and guide treatment with phototherapy. […] Early identification of infants at risk of severe hyperbilirubinemia is an essential component of newborn care; all newborns should be examined within 24 hours of birth and in the following two days.

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

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

  Conjugated hyperbilirubinemia (CHB), also referred to as neonatal cholestasis, is characterized by the elevation of serum conjugated (ie, direct) bilirubin (1.0 mg/dL) due to impaired hepatobiliary function. Distinguishing CHB from UHB is critical because cholestatic neonatal jaundice is almost always pathologic and warrants prompt evaluation and treatment. […] The causes of CHB are extensive and typically classified into the following categories: Infection, Obstruction of biliary flow, Genetic, Miscellaneous. […] The AAP recommends an infant’s bilirubin levels should be assessed between 24 and 48 hours after birth. If an infant leaves the hospital prior to this time frame, a bilirubin level should be measured before discharge home. […] Phototherapy and exchange transfusion are the mainstays of treatment for newborns with unconjugated hyperbilirubinemia. Other treatment modalities may be utilized based on patient response to these therapies. […] Treatment of conjugated hyperbilirubinemia is tailored to the specific etiology of the jaundice.

• #14 Diagnostics for Newborn Jaundice- Bilirubinometers – VIA Global Health

  https://viaglobalhealth.com/buyers-guides/newborn-jaundice/diagnostics-for-newborn-jaundice-bilirubinometers/

  Non-invasive technology is available in some healthcare facilities that will measure bilirubin by using an instrument placed on the skin, this is called transcutaneous bilirubinometry (TcB). Transcutaneous bilirubinometry (TcB) devices, or jaundice meters are based on the principle of multi wavelength spectral reflectance from the bilirubin staining in the skin and provide an opportunity for non-invasive, point-of-care monitoring to inform treatment decisions. […] The clinical accuracy of TcB and TSB levels are important to determine appropriate levels of phototherapy, in addition to other factors such as age and prematurity. […] Assessing a newborns response to phototherapy is important to determine dosing, duration, and changes in bilirubin levels. […] Understanding what to do with the results provided by either the TSB, TcB, or visual estimation should be informed by what treatment options are available under clinical supervision. Effective phototherapy, or in more extreme cases, exchange transfusion, relies on accuracy of bilirubin levels to determine if a baby should receive conventional or intensive phototherapy, and if there are other conditions that require care to be integrated with jaundice treatment.

• #15 Jaundice in Children: Causes, Symptoms, Diagnosis and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/jaundice-in-children

  If your baby is still jaundiced after 2 weeks of age, your provider will most likely order a blood test for total and direct bilirubin to better understand the type of jaundice and what other tests to do. […] Your babys health care provider will first examine your child for signs of jaundice. Other jaundice tests may include a blood test and a skin test. […] Physiologic jaundice often goes away without treatment within two weeks. […] Some babies need a treatment called phototherapy. […] If phototherapy does not bring down bilirubin levels low enough or fast enough, a baby with severe jaundice may need a blood exchange transfusion. […] For children with pathologic jaundice, the best course of treatment depends on the cause. […] Most often, jaundice is temporary and not harmful. […] If not properly treated, jaundice can lead to serious health issues. […] If jaundice is prolonged, severe, or pathologic, prompt attention, testing, and possibly treatment are important to prevent complications. […] The best way to be sure your baby recovers well from jaundice is to follow the advice of your babys health care provider.

• #16 Hyperbilirubinemia in the Term Newborn | AAFP

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

  The presence of jaundice can be determined by examining the infant in a well-lit room and blanching the skin with digital pressure to reveal the color of the skin and subcutaneous tissue. […] If the serum conjugated bilirubin level is above 2 mg per dL, the infant should be evaluated for possible hepatocellular disease or biliary obstruction.

• #17 Hyperbilirubinemia in the Term Newborn | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html/1000

  A more recent article on neonatal hyperbilirubinemia is available. […] A patient information handout on jaundice in infants, written by the authors of this article, is provided on page 613. […] Hyperbilirubinemia is one of the most common problems encountered in term newborns. […] Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness. […] The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity. […] Although up to 60 percent of term newborns have clinical jaundice in the first week of life, few have significant underlying disease.

• #17 Hyperbilirubinemia in the Term Newborn | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html/1000

  The only consistently reliable estimation of total serum bilirubin occurs when dermal icterus is confined to above the nipple line. […] The physical examination should focus on identifying one of the known causes of pathologic jaundice. […] If jaundice persists for more than two weeks in a formula-fed infant and more than three weeks in a breastfed infant, further evaluation is warranted. […] Conjugated hyperbilirubinemia is never physiologic, and it may indicate the presence of a potentially serious underlying disorder.

• #17 Hyperbilirubinemia in the Term Newborn | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p599.html/1000

  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 without identified risk factors rarely have total serum bilirubin levels above 12 mg per dL (205 mol per L). […] Common risk factors for hyperbilirubinemia include fetal-maternal blood group incompatibility, prematurity, and a previously affected sibling. […] The initial evaluation of jaundice depends on the age of the newborn. […] If the serum conjugated bilirubin level is above 2 mg per dL, the infant should be evaluated for possible hepatocellular disease or biliary obstruction. […] The presence of jaundice can be determined by examining the infant in a well-lit room and blanching the skin with digital pressure to reveal the color of the skin and subcutaneous tissue.

• #18 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. […] 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. […] Total SBR level should be used to determine management decisions in cases of predominantly unconjugated hyperbilirubinaemia.

• #19 Hyperbilirubinemia and Jaundice | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/hyperbilirubinemia-and-jaundice

  Treatment depends on many factors, including the cause of the hyperbilirubinemia and the level of bilirubin. The goal is to keep the level of bilirubin from increasing to dangerous levels while minimizing any negative effects of the treatment. […] While hyperbilirubinemia cannot be totally prevented, early recognition and treatment are important in preventing bilirubin levels from rising to dangerous levels.

• #20 Neonatal Hyperbilirubinemia – Pediatrics – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pediatrics/metabolic-electrolyte-and-toxic-disorders-in-neonates/neonatal-hyperbilirubinemia

  Phototherapy is the use of light to photoisomerize unconjugated bilirubin into forms that are more water-soluble and can be excreted rapidly by the liver and kidney without glucuronidation. […] Phototherapy remains the standard of care, most commonly using fluorescent white light. […] Exchange transfusion can rapidly remove bilirubin from circulation and is indicated for severe hyperbilirubinemia, which most often occurs with immune-mediated hemolysis. […] The need for treatment depends on cause and degree of bilirubin elevation; the more preterm the infant, the lower the threshold level for treatment.

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

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

  In some hospitals, screening for high bilirubin is at first performed by a device that measures bilirubin levels in the skin (referred to as „transcutaneous” screening). […] If a baby still has jaundice after one week of age, testing is also done to check bilirubin levels and rule out a serious condition (such as a liver condition that leads to delayed bilirubin removal). […] The goal of treating jaundice is to efficiently and safely reduce the level of bilirubin in the blood before it becomes toxic. […] Babies with higher bilirubin levels benefit from frequent assessment, and some will need treatment (which is usually brief). […] Phototherapy is the most common medical treatment for hyperbilirubinemia in babies. […] Phototherapy is usually given in a hospital. In some cases, it can be done at home if the baby is healthy and at lower risk for developing severe hyperbilirubinemia. […] Phototherapy is stopped when bilirubin levels in the blood drop to a safe level. […] 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.”

• #22 What Is Jaundice? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/jaundice/guide/

  Jaundice is common in newborns. When babies have jaundice, it usually goes away on its own, but in some cases, it can become severe and cause bigger issues. […] Newborns should be checked for jaundice at least every 8 to 12 hours in the first 48 hours of life and then again before 5 days old. Testing options include: Light Meter Here, a light meter is placed on a babys head to check the transcutaneous bilirubin (TcB) level. Blood Test The babys total serum bilirubin (TSB) level is tested after a small blood sample is taken from babys heel. This is the best way to accurately measure bilirubin levels in an infant. […] Treatment and medication options for jaundice differ for infants and adults. If a baby has moderate or severe jaundice, the following treatment options may come into play: Additional Feeding Your doctor may advise more frequent feedings or supplementation. Phototherapy Here, the baby is undressed down to a diaper and put under special blue-green lights that help break down bilirubin in the skin so that it can be excreted. Blood Protein Transfusion When babys jaundice is related to blood type incompatibility with mom, an IV transfusion of immunoglobulin (IVIg) may be required. Immunoglobulin is a blood protein that can reduce the level of antibodies that are contributing to the breakdown of baby’s red blood cells. Exchange Transfusion On rare occasions when severe jaundice doesnt respond to earlier treatments, the baby may require whats called an exchange transfusion of blood. Here, small amounts of blood are repeatedly withdrawn and then replaced with donor blood. This process helps dilute bilirubin and antibodies from the mother.

• #23 Hemolytic causes of neonatal jaundice: diagnosis and treatment – Bahr – Pediatric Medicine

  https://pm.amegroups.org/article/view/6462/html

  The Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP), in its 2004 guideline, emphasizes the high risk of developing hyperbilirubinemia associated with hemolysis. […] The practical aspects of both increased risk for hyperbilirubinemia and neurotoxicity in association with hemolysis are manifest in the recommendations of the 2004 AAP guideline, in which a more aggressive approach is adopted in babies with hemolysis than in those without an obvious hemolytic condition. […] When neonatal jaundice is found to be the result of hemolysis, caregivers should be aware that: (I) the TSB level can rise rapidly; (II) the hyperbilirubinemia might be slow to fall even with intensive phototherapy; and (III) the hyperbilirubinemia is likely to rebound after phototherapy is discontinued.

• #24 4 Hyperbilirubinemia (Neonatal Jaundice) Nursing Care Plans

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

  The neonate will display indirect bilirubin levels below 12 mg/dl in term infants at three days of age. […] The neonate will show resolution of jaundice by the end of the 1st wk of life. […] The neonate will be free of CNS involvement. […] The neonate will complete the exchange transfusion without complications. […] The neonate will display decreasing serum bilirubin levels. […] The neonate will maintain body temperature and fluid balance within the normal limits. […] The neonate will be free of skin/tissue injury. […] The neonate will demonstrate expected interaction patterns. […] The neonate will display decreasing serum bilirubin levels. […] Kernicterus is caused by a high bilirubin level in a baby’s blood. If left untreated, the bilirubin can then spread into the brain, where it causes long-term damage, which includes cerebral palsy, mental retardation, sensory difficulties, delayed speech, poor muscle coordination, learning difficulties, and enamel hypoplasia or yellowish-green staining of teeth, and even death.

• #25

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

  Jaundice in newborn babies is common and usually harmless. It causes yellowing of the skin and the whites of the eyes. The medical term for jaundice in babies is neonatal jaundice. […] Your baby will be examined for signs of jaundice within 72 hours of being born as part of the newborn physical examination. […] While jaundice is not usually a cause for concern, it’s important to determine whether your baby needs treatment. […] If tests show very high levels of bilirubin in a baby’s blood, treatment is usually only recommended. […] 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.

• #26 What are Jaundice and Kernicterus? | CDC

  https://archive.cdc.gov/www_cdc_gov/ncbddd/jaundice/facts.html

  Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. […] The babys doctor or nurse can test how much bilirubin is in the babys blood. […] At a minimum, babies should be checked for jaundice every 8 to 12 hours in the first 48 hours of life. […] A doctor or nurse may check the babys bilirubin using a light meter that is placed on the babys head. […] The best way to accurately measure bilirubin is with a small blood sample from the babys heel. […] If the level is high, based upon the babys age in hours and other risk factors, treatment will likely follow. […] Early detection and management of jaundice can prevent kernicterus. […] If you think your baby has jaundice you should call and visit your babys doctor right away. […] Ask your babys doctor or nurse about a jaundice bilirubin test.

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

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

  Hyperbilirubinemia happens when there is too much bilirubin in your babys blood. […] Jaundice can happen if your babys liver doesnt work well. This may be because of an infection or other factors. The liver is the part of the body most responsible for getting rid of bilirubin. A problem with the liver can cause higher levels of bilirubin. […] About 60% of full-term newborns get jaundice. So do 80% of premature babies. Babies born to mothers with diabetes or Rh disease are more likely to have this condition. […] The timing of when your childs jaundice first starts matters. It may help his or her healthcare provider make a diagnosis. […] Your childs healthcare provider may do these tests to confirm the diagnosis: Direct and indirect bilirubin levels. These levels show if bilirubin is bound with other substances by your childs liver. Normal physiologic jaundice has indirect bilirubin. Jaundice due to more serious problems can have high levels of either type of bilirubin. […] Spotting jaundice early and getting treatment right away are key. This can stop your childs bilirubin from rising to dangerous levels.

• #28 Newborn Jaundice: Diagnosis, Treatment & Long-Term Effects – Avisena Women’s & Children’s Specialist Hospital

  https://awcsh.avisena.com.my/health-articles/newborn-jaundice-diagnosis-treatment-and-long-term-implications/

  Newborn jaundice, medically known as neonatal hyperbilirubinemia, occurs when a babys blood contains an excess amount of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. […] Diagnosis of newborn jaundice involves several steps to determine bilirubin levels and identify underlying causes: […] If jaundice is suspected, the level of bilirubin in the blood is measured using either a transcutaneous bilirubinometer or a blood test. The American Academy of Pediatrics (AAP) provides guidelines for bilirubin levels that require intervention based on the babys age in hours and other risk factors. […] The treatment approach for newborn jaundice depends on the severity and underlying cause. Here are the common treatment options: […] Monitoring bilirubin levels and the babys overall health is essential during and after treatment. Paediatricians often schedule follow-up visits to ensure bilirubin levels are decreasing and to check for any signs of complications.

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