3. RISK
FACTORS
•
Jaundice within first 24 hrs of birth
•
A sibling who was jaundiced as neonate
•
Unrecognised hemolysis (ABO- or Rh-
incompatibility)
•
Non optimal sucking nursing
•
Deficiency of G6PD
•
Infection
•
Cephalhematomas bruising
•
East Asian or Mediterranean descent
4. PREVENTABLE CAUSES OF KERNICTERUS
•
The American Academy of Pediatrics has identified potentially preventable causes of kernicterus, as follows:
(1)
early discharge (<48 hr) with no early follow-up (within 48 hr of discharge); this problem is particularly
important in near-term infants (35-37 wk of gestation);
(2)
failure to check the bilirubin level in an infant noted to be jaundiced in the 1st 24 hr;
(3)
failure to recognize the presence of risk factors for hyperbilirubinemia;
(4)
underestimation of the severity of jaundice by clinical (visual) assessment;
(5)
lack of concern regarding the presence of jaundice;
(6)
delay in measuring the serum bilirubin level despite marked jaundice or delay in initiating phototherapy in
the presence of elevated bilirubin levels; and
(7)
failure to respond to parental concern regarding jaundice, poor feeding, or lethargy.
8. PREVENTION
• Universal screening for hyperbilirubinemia in the 1st 24-48 hr
after birth to detect infants at high risk for severe jaundice and
bilirubin induced neurologic dysfunction.
• Protocols
• Hour-specific bilirubin nomogram
• Physical examination, and
• Clinical risk factors
9. MANAGEMENT
•
The following approach is further recommended:
(1)
any infant who is jaundiced before 24 hr requires measurement of total and
direct serum bilirubin levels and, if it is elevated, evaluation for possible hemolytic
disease and
(2)
follow-up should be provided within 2-3 days of discharge to all neonates
discharged earlier than 48 hr after birth.
•
Early follow-up is particularly important for infants younger than 38 wk of
gestation.
•
Parental communication with regard to concerns about infant’s skin color and
behavioral activities should be addressed early.
•
Mothers should be advised to nurse their infants every 2-3 hr and to avoid
routine supplementation with water or glucose water in order to ensure
adequate hydration and caloric intake.