Nursing care plan for hyperbilirubinemia of the newborn. Prior to publication of the 1994 aap recommendations, the pediatric literature was notable for several articles on a kinder, gentler, demedicalized management of neonatal hyperbilirubinemia because of the apparent lack of evidence of bilirubin neurotoxicity in term, apparently healthy babies cared for in the well baby nurseries of the us. Medstar health these guidelines are provided to assist physicians and other clinicians in making decisions regarding the care of their patients. Nomogram for designation of risk in 2840 well newborns at 36 or more weeks gestational age with birth weight of 2000 g or more or 35 or more weeks gestational age and birth weight of 2500 g or more based on the hourspecific serum bilirubin values. The tsb concentrations vary greatly in infants, depending on race, type of feeding, and genetic factors. The prevention, detection and management of jaundice in term and late preterm newborn infants remains a challenge 24. In general, perform extx for cord bilirubin 5 mgdl, for a rate of rise of bilirubin 0.
Elimination of bilirubin is often delayed in preterm infants. Jaundice is not painful, but in some babies, serious conditions can occur if hyperbilirubinemia is not treated. Evaluation and treatment of neonatal hyperbilirubinemia karen e. Recent advances in the management of neonatal jaundice. Generally, the physiological jaundice is the most prevalent type however in some regions pathological jaundice is also common. Phototherapy to prevent severe neonatal hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Jaundice in newborn younger than 24 hours or yellow palms and soles at any. For most newborns, such deposition is of little consequence, but the potential remains for kernicterus from high bilirubin concentrations or lower bilirubin concentrations in preterm infants. Jaundice occurs when the liver fails to adequately. Management of neonatal indirect hyperbilirubinemia in late preterm and term neonates has been well addressed by recognized, consensusbased guidelines. Critical hyperbilirubinemia a tsb concentration greater than 425.
Conjugated hyperbilirubinemia is always pathologic when the total bili is quite high, the conjugated fraction can rise to as high as 20% of the total, although it usually stays under 1. Mean peak total serum bilirubin is 6 mgdl higher in asian infants. Neonates underwent periodic monitoring of total bilirubin levels measured in. A common condition, it can occur when babies have a high level of bilirubin, a yellow pigment produced during the breakdown of red.
It is a common condition that occurs in the first week of the newborn. A study of various causes of indirect hyperbilirubinemia in neonates saeed ahmad malik1, muhammad aurangzeb malik2, saadia aurangzeb malik3 abstract background. Neonatal indirect hyperbilirubinemia is one of the most frequent neonatal problems that affect almost two thirds of term infants. Early onset conjugated hyperbilirubinemia in newborn infants. In healthy term newborns encouragement of continued and frequent breastfeeding at least eight to ten times every 24 hours is recommended. G6pd deficiency, whose frequency is unknown in the absence of a reliable neonatal screen. The key objectives of the qbp for hyperbilirubinemia are to. Neonatal hyperbilirubinemia merck manuals professional edition. To augment caloricfluid intake in the setting of suboptimal intake jaundice, supplement with pumped breast milk, donor breast milk or formula. Management of hyperbilirubinemia in the newborn infant 35.
A systembased approach that is based on universal predischarge bilirubin screening and the best available evidence to date that is efficient, less costly and most importantly safer for all newborns 12, 24, 25, 26. Systematic followup of hyperbilirubinemia in neonates with a gestational age of 35 to 37 weeks. Jaundice, a sign of elevated bilirubin levels, occurs in 60% of term and 80% of preterm newborns during the first week of life. Bilirubin chart for newborn babies medical health tests. Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring. Original article causes and management of hyperbilirubinemia in fullterm newborns yanping zhu 1, jun wang2, mingxia li 1department of neonatology, the first affiliated hospital of xinjiang medical university, urumqi, xinjiang 830000. Guideline treatment of the hemolytic and nonhemolytic 2500 gram newborn see graph 1 guideline treatment of the hemolytic and nonhemolytic newborn see graph 2 use total serum bilirubin if the direct bilirubin bilirubin levels before discharge may provide quantitative measurement that could aid management.
Breast feeding, with elevated bilirubin in 1015% of breast fed newborns 3. Kernicterus is the most severe form of neurotoxicity. Guidelines for detection, management and prevention of. Hyperbilirubinemia in the newborn infant 35 weeks gestation. The term jaundice is from the french word jaune, which means yellow. Neonatal jaundice refer to online version, destroy printed copies after use page 6 of 40 list of tables table 1. University of groningen the management of hyperbilirubinemia in.
Drawing blood from the baby causes pain and sometimes leads to psychological trauma. Hyperbilirubinemia is a condition in which there is a build up of bilirubin in the blood, causing yellow discoloration of the eyes and skin, called jaundice. Current literature reports that combining clinical risk factors with bilirubin. Haemolytic disease of the newborn hdn is characterised by a breakdown of red blood cells rbc by maternal antibodies. In healthy term newborns encouragement of continued and frequent breastfeeding at. Jaundice is a yellowish discoloration of the skin and sclerae that is an important symptom of elevated serum bilirubin, which is caused by an abnormality of bilirubin metabolism or excretion. Nomogram for designation of risk for hyperbilirubinemia in 2,840 well newborns at 36 or more weeks gestational age whose birthweights. Definitions 3 umhs neonatal hyperbilirubinemia guideline october 2017 direct or conjugated hyperbilirubinemia. Bilitool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or jaundice in newborns over 35 weeks gestational age. Abo incompatibility, a cause of early hyperbilirubinemia in 12% of infants 4.
Management of hyperbilirubinemia in the newborn period. Combining clinical risk factors with serum bilirubin levels to predict. Hyperbilirubinemia, or jaundice, is a life threatening disorder in newborns. About 60% of fullterm newborns and 80% of premature babies get jaundice. Strategies for neonatal hyperbilirubinemia request pdf. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin. Hyperbilirubinemia self learning module updated july 2015 final. American academy of pediatrics clinical practice guideline subcommittee on hyperbilirubinemia management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation abstract.
Neurotoxicity is the major consequence of neonatal hyperbilirubinemia. A systems approach for neonatal hyperbilirubinemia in term. Jaundice is the most common cause of readmission after discharge from birth hospitalization. Most newborns with jaundice can continue breastfeeding. Neonatal hyperbilirubinemia in newborns of the republic of north.
Transfer of newborn from well newborn to the floor. Advances in the clinical assessment strategies used to identify neonates at risk for the development of severe hyperbilirubinemia and bilirubin neurotoxicity, as. New evidence suggests that combining a predischarge measurement of tsb. Therefore, about the second to fourth day after birth, the skin and eyes become yellowtinted.
Bilirubin, a product from the normal breakdown of red blood cells, is elevated in newborns for several reasons. Hyperbilirubinemia in the newborn american academy of. Hyperbilirubinemia care guidelines for emergency department management inclusion criteria. A bilirubin chart newborn babies is like a graph or a chart, which can help to measure the levels of bilirubin in a newborn babys blood. Neonatal jaundice in asian, white, and mixedrace infants. Hyperbilirubinemia in newborns description these guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Key points about hyperbilirubinemia in the newborn. Existing method requires blood samples for the detection of hyperbilirubinemia in neonates.
This may also account for the wide variation in the etiology of. Qualitybased procedure qbp titled hyperbilirubinemia in term and late preterm infants. Newborn with increased blood levels of bilirubin leads to hyperbilirubinemia or jaundice. The timing of when your childs jaundice first starts matters. Pdf neonatal jaundice nnj occurs in 60% of term and 80% of preterm babies. Complications may include seizures, cerebral palsy, or kernicterus. Yellow color to skin and eyes, or high levels of bilirubin in the blood at in babies that requires medical evaluation and treatment. Manage neonatal hyperbilirubinemia, including referral to the neonatal intensive care unit for exchange transfusion. Neonatal jaundice is a yellowish discoloration of the white part of the eyes and skin in a newborn baby due to high bilirubin levels. Provide lactation evaluation and support for all breastfeeding mothers.
Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored. However some conditions like prematurity, infection. Management of indirect neonatal hyperbilirubinemia michigan. Management of indirect neonatal hyperbilirubinemia patient population. This document is only valid for the day on which it is accessed. It is, however imperative to identify newborns with jaundice that do not follow this pattern as failure to do so may lead to longterm sequelae. A systems approach for neonatal hyperbilirubinemia in term and nearterm newborns. Hyperbilirubinemia care guidelines for emergency department.
Combine blood testing to reduce number of venepunctures to baby. Neonatal jaundice is a fairly common cause of morbidity in pakistan and accounts for almost 25% of all newborn admissions1. Telemetry system for early detection of hyperbilirubinemia. Several health experts are known to use a neonatal bilirubin chart, or an infant bilirubin chart, so that they can keep a track of the amount of bilirubin that is. Many newborn babies develop jaundice, a condition in which the skin and whites of the eyes are yellowish in color, within a few days after birth. Predictive ability of a predischarge hourspecific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and nearterm newborns. Hyperbilirubinemiajaundice clinical pathway inpatient. Always check a total and direct, so that you can be sure you are excluding conjugated hyperbilirubinemia, which has totally different etiologies and treatments. Newborns most at risk for hyperbilirubinemia are those who are preterm, who display bruising, or who have blood incompatibilities, an enclosed hemorrhage such as cephalhematoma, polycythemia, an intrauterine infection, congenital red blood cell abnormality, or congenital hypothyroidism or galactosemia. The rate of jaundice diagnosis among infants with asian mothers and white fathers was not substantially different from that of white infants. In many cases there is no specific underlying disorder physiologic.
The serum bilirubin level required to cause jaundice varies with skin tone and body region, but jaundice usually becomes visible on the sclera at a level of 2 to 3 mgdl 34 to 51 mcmoll and on the face at about 4 to 5 mgdl 68 to 86 mcmoll. However, infants with asian fathers and white mothers had a 32% greater risk relative to white infants, suggesting a stronger paternal influence in determining an infants risk of jaundice. Managing newborn hyperbilirubinemia and preventing kernicterus. Learn about the causes, definition, symptoms, and treatment of jaundice in newborns. In general, jaundice becomes evident at serum bilirubin concentrations greater than 3 mgdl in older children and greater than 5 mgdl in newborns. This happens because of an increased amount of a protein called bilirubin. Other symptoms may include excess sleepiness or poor feeding.
Although it is now rare, kernicterus still occurs and can. Total serum bilirubin tsb nomogram for designation of risk in 2,840 well newborns delivered at 36 or more weeks gestation with birth weight of at least 2,000 g 4 lb, 7 oz, or those. Hyperbilirubinemia happens when there is too much bilirubin in your babys blood. Guidelines for management of jaundice in the breastfeeding infant equal to or greater than 35 weeks gestation. For most babies, jaundice will get better without treatment within 1 to 2 weeks. Combining the results of the studies, we propose a set of recom mendations on the. The condition is almost always diagnosed before the level becomes high enough to cause this damage. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants 35 or more weeks gestation summary. Transcutaneous bilirubin measurements in preterm infants. Hyperbilirubinemia and jaundice childrens hospital of. These results indicate that phototherapy effectively reduces bilirubin levels in bf newborns with hyperbilirubinemia. Elevation of the bilirubin level in the newborn s blood, which results in yellowish staining of the skin and whites of the newborn s eyes sclerae by pigment of bile bilirubin. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Major risk factors for hyperbilirubinemia in fullterm newborns.
Jaundice is also known as icterus, from the ancient greek word ikteros, signifying jaundice. Jaundice is a yellow discoloration of the skin and eyes caused by hyperbilirubinemia elevated serum bilirubin concentration. 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. Jaundice in the newborns jaundice is the most common morbidity in the first week of life, occurring in 60% of term and 80% of preterm newborn. Pdf after completing this article, readers should be able to. While all newborns have some degree of jaundice, late preterm infants. To prevent and reduce the incidence of neonatal hyperbilirubinemia encephalopathy and kernicterus. Management of hyperbilirubinemia in the newborn infant 35 or more weeks. The bilirubin can be either unconjugated or conjugated. It is a hallmark of liver disease but not always present in liver disease. The presence of jaundice on clinical examination indicates hyperbilirubinemia, which is defined as a total serum bilirubin greater than 1. Policy statement all newborns greater than 35 weeks gestation will have serum bilirubin sb or transcutaneous bilirubin tcb measured within the first 72 hours of life.
Umhs neonatal hyperbilirubinemia guideline october 2017. The term jaundice, derived from the french word jaune, meaning yellow, is a yellowish discoloration of the skin, sclerae, and mucous membranes that is caused by tissue deposition of pigmented bilirubin. Jaundice hyperbilirubinaemia and phototherapy page 5 of neonatal guideline clinical assessment of the jaundiced infant jaundice can be readily detected in the newborn. Pathogenesis and management of indirect hyperbilirubinemia. Total serum bilirubin tsb concentrations peak in the. Care of the preterm and lowbirthweight newborn 10 7.
Infants discharged 48 hours after birth should be examined by a health care provider within 2 to 3 days to receive routine followup visits and a jaundice assessment. Jaundice is a yellowish discoloration of the skin, sclerae, and mucous membranes resulting from deposition of the bile pigment bilirubin. This guideline applies to the management of indirect hyperbilirubinemia in neonates less than 8 days of life and 35 weeks gestation or more. Jaundice is a common clinical sign in newborns, especially during the first 2 weeks after birth. Hyperbilirubinemia in the newborn health encyclopedia. Clinical practice guideline for the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Unconjugated bilirubin is a waste product of hemoglobin breakdown that is taken up by the liver. Breastfeeding, jaundice and hyperbilirubinemia in the newborn. Symptoms include yellowing of the skin, mucous membranes, and whites of the eyes.
Pdf hyperbilirubinemia in the newborn researchgate. Decisions about supplementation of a jaundiced newborn should be made on a casebycase basis. Jaundice is not a disease, but rather a sign of an elevated blood bilirubin level. This medical condition is called hyperbilirubinemia because hyper increased, bilirubin bilirubin, and emia in the bloodstream.
Management of other severe conditions 15 neonatal seizures 15 neonatal jaundice 16 necrotizing. Preserving breastfeeding for the hospitalized infant. It is a multifactorial disorder with many symptoms. The condition may be benign or may place the neonate at risk for multiple complicationsuntoward effects. American academy of pediatrics subcommittee on hyperbilirubinemia.
These infants show a significantly slower response to this treatment than ff. Feb 03, 2020 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. Supplementation may be done with a supplemental nursing system sns, cup, syringe or bottle feeding. Neonatal jaundice physiologic jaundice nonpathologic unconjugated hyperbilirubinemia.
Management of newborn and young infant illnesses 7 4. It happens because babies livers are not yet able to get rid of extra bilirubin in the blood. Management of hyperbilirubinemia in the healthy term newborn. Muchowski, md, naval hospital camp pendleton family medicine residency program, camp pendleton, california n eonatal jaundice affects up to 84% of term newborns1 and is the most common cause of hospital readmission in the neonatal period. A study of various causes of indirect hyperbilirubinemia in. To determine the causes and related outcomes of early onset conjugated hyperbilirubinemia in a group of newborn infants and to determine the incidence of sepsis in these neonates. Because the bilirubin has a color, it turns babies shin and eyes yellow jaundice. Total serum bilirubin peaks at age 35 d later in asian infants. Neonatal hyperbilirubinemia pediatrics merck manuals. Jaundice results from bilirubin deposition in the skin and mucous membranes. A very high level of bilirubin can damage the brain. Feeding of newborns is compatible with management of hyperbilirubinemia. After conjugation in the liver, it is excreted in bile. Sixty per cent of term newborns develop jaundice, and 2% exceed a tsb concentration of 340.
Low levels of bilirubin in the newborn is common and does not cause any trouble and will resolve on its own in the first week of life. The most common symptom is yellowing of your babys skin and the whites of his or her eyes. Premature infants have a higher incidence of indirect hyperbilirubinemia than term infants. The presence of jaundice allows doctors to identify babies who are at risk of developing severe hyperbilirubinemia. Hyperbilirubinemia is one of the most common problems encountered in term newborns. Newborns have a higher rate of bilirubin production due to the shorter lifespan of red blood cells and higher red blood cell concentration compared to adults. Hyperbilirubinemia, excess bilirubin in the blood, is an extremely common problem occurring during the newborn period. Original article causes and management of hyperbilirubinemia.
An acute encephalopathy can be followed by a variety of neurologic impairments, including cerebral palsy and sensorimotor deficits. Newborn jaundice is a yellowing of a babys skin and eyes. Tsb levels in late preterm infants may peak later as compared with term infants, and rate of rise may be steeper jaundice should resolve by 2 weeks of life in most infants. Jaundice american academy of pediatrics textbook of. Systematic followup of hyperbilirubinemia in neonates with a. Recent advances in the management of neonatal jaundice jon f watchko division of newborn medicine, department of pediatrics, university of pittsburgh school of medicine, mageewomens research institute, pittsburgh, pa, usa abstract. The liver normally absorbs and processes bilirubin, but in the newborn there are not enough enzymes present yet for the liver to absorb and metabolize the bilirubin. Approximately 5060% of newborn infants will become jaundiced during the first week of life.
Care for all babies identify babies as being more likely to develop significant hyperbilirubinaemia if they have any of the following factors. Neonatal jaundice in most newborns is a mild and transient event. Congenital hyperbilirubinemia definition of congenital. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic.
Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. Neonatal jaundice is yellowish discoloration of the skin, conjunctiva and the sclera from elevated serum or plasma bilirubin in the newborn period. Evaluation and treatment of neonatal hyperbilirubinemia. Jaundice in newborns hyperbilirubinemia jaundice makes a babys skin and whites of the eyes look yellow. Management of hyperbilirubinemia in the healthy term newborn by age in hours treatment of jaundice associated with breastfeeding in the healthy term newborn. Bilirubin is the yellow pigment that is left over when red blood cells break down. Bilirubin secretion, jaundice and evaluation of liver function. Hyperbilirubinemia is the commonest morbidity in the neonatal period and 510% of all newborns require intervention for pathological jaundice.
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