Anemia of Prematurity - Portal Neonatal

FOLLOW-UP Section 8 of 11
Further Inpatient Care:
• Infants who have been treated for jaundice can be discharged when they are feeding
adequately and have had 2 successive serum bilirubin levels demonstrating a trend towards
lower values.
• If the hospital does not routinely screen newborns for auditory function, ordering such tests
prior to discharge is advisable in infants who have had severe jaundice.
Further Outpatient Care:
• In the era of early discharge, newborns released within the first 48 hours of life need to be
reassessed for jaundice within 1-2 days. Use of the hour-specific bilirubin nomogram (see
Nomogram) may assist in selecting infants with a high likelihood of developing significant
hyperbilirubinemia.
• Telephone consultations are not recommended because parental reports cannot be gauged
appropriately. In recent years, a number of infants have developed kernicterus, resulting, at
least in part, from inadequate communication between physicians or their representatives and
parents.
• Availability of new devices for transcutaneous measurement of bilirubin levels should facilitate
follow-up evaluations of infants discharged before 48 hours of life.
• Home phototherapy
o Home phototherapy is used in an effort to limit the high cost of applying such therapy
in hospitals. Home treatment can avoid or limit parent-child separation. Home
treatment should be used with caution, since prevention of neurotoxicity is the goal.
Some physicians argue that an infant at risk for neurologic damage should not be at
home.
o With effective treatment strategies, the average duration of phototherapy in the
regular neonatal nursery at the author's institution is less than 17 hours. Whether the
effort and cost to set up home therapy is worthwhile is debatable. This assessment
may be different in different socioeconomic and health financing circumstances.
• Infants who have been treated for hemolytic jaundice require follow-up observation for several
weeks because hemoglobin levels may fall lower than seen in physiologic anemia. Erythrocyte
transfusions may be required if infants develop symptomatic anemia.
Complications:
• Kernicterus
Prognosis:
• Prognosis is excellent if the patient receives treatment according to accepted guidelines.
• Brain damage due to kernicterus remains a true risk, and the increased incidence of
kernicterus in recent years may be due to the misconception that jaundice in the healthy fullterm
infant is not dangerous and can be disregarded.