RESidENcy PROGRAM Scholarly and Community Medicine Projects

Management of Hyperbilirubinemia
● Secondary prevention 6
● Test all mothers for ABO and Rh type + Ab screen
● If no typing done on mother, perform direct Coombs'
test, and ABO/Rh on infant cord blood
● Obtain direct bilirubin for sick infants and those
jaundiced > 3weeks
● If direct (conjugated) bilirubin elevated, obtain UA and
urine cx. Further lab testing for sepsis if H&P suggests
sepsis; also evaluate for cholestasis
● GP6D testing for infants receiving phototherapy AND
family Hx or geographic origin suggests ↑ risk OR poor
response to phototherapy
Treatment
● Dictated by hour-specific bilirubin levels plotted on appropriate
nomogram (based on GA, risk factors).
● Use TOTAL bilirubin levels
● TSB at level for exchange transfusion or >25mg/dL –
MEDICAL EMERGENCY → transfer f di directly l to hhospital i lwith i h
pediatric specialist21 ● If TSB does not fall (or continues to rise) despite phototherapy,
hemolysis is likely
● Consider IV γ-globulin (0.5-1 g/kg over 2 hrs, may repeat x1
in 12 hours) 22
● Serum albumin
Treatment (cont'd)
● Consider measuring and if < 3g/dL, use as risk factor in
determining phototherapy threshold
● Exchange transfusion – calculate bilirubin/albumin (B/A)
ratio
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