HYPERBILIRUBINEMIA.ppt

7/27/2019 HYPERBILIRUBINEMIA.ppt

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Management of

Hyperbilirubinemiain the newborn infant 35or more weeks of gestation

Clinical Practice Guideline

American Academy of Pediatrics


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BILIRUBIN

............................................By-product of heme metabolism

Excreted through stool and urine

Fat-soluble

Hyperbilirubinemia


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JAUNDICE

............................................ Yellowish discoloration of the skin and sclera

Common in most newborn infants

Benign but has potential for bilirubin toxicity =

KERNICTERUS

Risk factors

Management


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K E Y E L E M E N T S

Promote and support successfulbreastfeeding

Establish protocols in the theidentification and evaluation of

hyperbilirubinemia

Measure the total serum bilirubin(TSB)

or transcutaneous bilirubin (TcB) level on

infants jaundiced within 24 hours

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Recognize that visual estimation of the degree of

jaundice can lead to errors, particularly in darkly

pigmented infants

Interpret all bilirubin levels in infant's age inhours

Recognize that infants at less than 38 weeks'particularly those who are breastfed, are at

higher risk of developing hyperbilirubinemia

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Perform a systematic assessment on all

infants before discharge for the risk of

severe hyperbilirubinemia

Provide parents with a written and

verbal information about newborn

jaundice

Provide appropriate follow-up based on

time of discharge and the risk

assessment

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Pre-discharge TSB in the high-risk zone

Jaundice observed in the first 24 hours

Blood group incompatibility

Prematurity Cephalohematoma or significant bruising

Exclusive breastfeeding

East Asian race Previous sibling received phototherapy

Risk factors for development of Severe

Hyperbilirubinemia

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Infant Discharged Should be seen by age

Before age 24 hours 72 hours

Between 24 48 hours 96 hours

Between 48- 72 hours 120 hours

Follow-up should be provided as

follows:

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Treat newborns, when indicated with

phototherapy or exchange transfusion

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SUMMARY

Promote and support successful

breastfeeding

Perform a systematic assessment

before discharge for the risk of

hyperbilirubinemia

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2


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SUMMARY

Provide early and focused follow-up

based on the risk assessment

Treat newborns with phototherapy

or exchange transfusion when

indicated

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Thank you!

PRACTICAL TIPS


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PRACTICAL TIPS

Cover BOTH eyes and genitals formales. Cover only the eyes for females

Phototherapy must be at least 12

inches away from the chest Turn at least 2 3 hours to expose the

back and sides

Cepahlo-caudal progression

Remember bilirubin levels are

interpreted in HOURS

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ANSWERS


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1. 35 or more weeks of gestation

2-3. 12 inches away from the infant's body; eyes

and genital with protective covering

4. 72 hours

5-6. Bilirubin > 25 mg/ml; bilirubin levels notdecreasing despite intensive phototherapy

7-10. RISK FACTORS for developing Severe

Hyperbilirubinemia

ANSWERS

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HYPERBILIRUBINEMIA.ppt

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