Neonatal Jaundice: When Do the Light Bulbs Go On? - Trinity Health

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Important Risk Factors-Significant Hyperbilirubinemia (Continued) • Isoimmune hemolytic disorder (e.g., ABO or Rh incompatibility, other)-Direct Antiglobulin Test (+) (most) • Other hemolytic disorder – Membrane or structural disorder- (e.g.,spherocytosis) – Enzyme deficiency (e.g.,G6PD deficiency, pyruvate kinase) • Previous sibling who required phototherapy • Cephalohematoma or significant ecchymoses • Polycythemia • East Asian Race *TSB/TcB: Total Serum Bilirubin/Transcutaneous Bilirubin Maisels, MJ et al Pediatrics 2009; 124: 1193
Neonatal Hyperbilirubinemia: ABO Incompatibility • MOther’s blood type O, BABy A or B PLUS – Positive Direct Antiglobulin Test (DAT, Direct Coombs Test)—Common • B antigen stronger than A antigen of infants born to O mothers • 33% of A or B infants born to O mothers have anti A or B antibodies (IgG) attached to RBC (20% of these with significant hyperbilirubinemia) • ABO Hemolytic disease may occur with negative Coombs or DAT – Jaundice often present first 24 hours, but uncommon reason for readmission – Gilbert Syndrome genotype (?) if prolonged jaundice (breast milk?) – Rare late anemia (in contrast to Rh isoimmunization) – High risk factor-use hour specific nomogram (Bhutani, VK et al Pediatrics 1999: 103:6) + phototherapy/exchange transfusion nomogram • Start phototherapy 2-5mg/dL lower than for usual patient
Page 1: Perinatal Symposium--2012 “Neonat
Page 4 and 5: Neonatal Hyperbilirubinemia • Pat
Page 7 and 8: Neonatal Indirect-Unconjugated Hype
Page 9 and 10: Neonatal Hyperbilirubinemia Bilirub
Page 11 and 12: Neonatal Hyperbilirubinemia • Gen
Page 13 and 14: Neonatal Hyperbilirubminemia TSB LE
Page 15 and 16: Important Risk Factors-Significant
Page 17 and 18: Breastfeeding versus Breast Milk Ja
Page 19: Adequacy of Breast Feeding • Adeq
Page 23 and 24: » EVALUATION-NEONATAL JAUNDICE
Page 25 and 26: 2 3 1 4 5 Neonatal Jaundice Dermal
Page 27 and 28: Neonatal Hyperbilirubinemia-Patholo
Page 29 and 30: Additional Evaluation of Neonatal H
Page 31 and 32: Monitoring with Transcutaneous Bili
Page 33 and 34: Transcutaneous Bilirubinometry Scre
Page 35 and 36: Common Causes of Prolonged (3 weeks
Page 37 and 38: Neonatal Hyperbilirubinemia • Pat
Page 39 and 40: Maisels MJ, Mcdonagh AF. Mechanism
Page 41 and 42: Factors Related to Efficacy of Phot
Page 43 and 44: Mangement Under Phototherapy (Conti
Page 45 and 46: Bili Tool • Risk for development
Page 47 and 48: Phototherapy-Hospital, Home • Bil
Page 49 and 50: PREVENTION - SEVERE HYPERBILIRUBINE
Page 51 and 52: Patient 2 (Continued) In the ER, th
Page 53 and 54: Kernicterus • Can occur in health
Page 55 and 56: Kernicterus • Can NOT associate a
Page 57 and 58: Predictive Ability of a Pre Dischar
Page 59 and 60: Predischarge Risk Zone Bilirubin Le
Page 61 and 62: Hyperbilirubinemia in the Newborn I
Page 63 and 64: Commentary on Hyperbilirubinemia in
Page 65 and 66: Screening of Infants for Hyperbilir
Page 67 and 68: » SUMMARY
Page 69 and 70: Ten Key Recommendations for Prevent
Page 71 and 72:
Maroon and Gold Summary Points •
Page 74 and 75:
References: General American Academ
Page 76 and 77:
References: Breast Feeding de Almei
Page 78 and 79:
References Bilirubin Predischarge S
Page 80:
References: Kernicterus Davidson L,
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Neonatal Jaundice: When Do the Light Bulbs Go On? - Trinity Health

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