Approach to managing hyperbilirubinemia in term newborns
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The document discusses the approach to managing hyperbilirubinemia in term newborn infants. It covers the definition and significance of neonatal hyperbilirubinemia. It also discusses the classification of jaundice as physiologic, breast milk, or pathologic. Guidelines are provided for prevention, screening, treatment with phototherapy or exchange transfusion, and follow-up after discharge. Risk factors for severe hyperbilirubinemia are identified.
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Approach to managing hyperbilirubinemia in term newborns
- 1. Approach to the management of Hyperbilirubinemia in Term Newborn Infant Mohammadh Khassawneh MD
- 4. Bilirubin Production & Metabolism
- 7. Physiologic Jaundice Asian infant Breastfed infant Non-breastfed infant
- 10. Mechanism of Physiologic Jaundice Increased rbc’s Shortened rbc lifespan Immature hepatic uptake & conjugation Increased enterohepatic Circulation
- 22. 2004 AAP Guidelines Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia Pediatrics 2004; 114;297-316
- 26. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 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 hour-specific serum bilirubin values
- 30. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Algorithm for the management of jaundice in the newborn nursery
- 33. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation
- 43. QUESTIONS?
Notes de l'éditeur
- Jaundice < 24 hours = pathologic; check TSB or TcB Jaundice appears excessive for age = TSB or TcB The need for and timing of a repeat bili depends on the zone in which TSB falls, age of infant Interpret all bili levels according to infant’s age in hours
- Use total bili Risk factors = isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin < 3.0 Can use home phototherapy if no risk factors Based on limited evidence Use intensive phototherapy when TSB exceeds line If TSB doesn’t decrease or rises strongly suggests hemolysis If TSB > 25 or at level recommending exchange transfusion it is a med emergency and requires admission Isoimmune hemolytic disease: IV gamma globulin (.50-1 g/kg over 2 hrs) if TSB rising on phototherapy or within 2-3 mg/dL of exchange transfusion recommendations. Can repeat dose in 12 hours. Shown to decrease need for exchange transfusion