In 2004, the American Academy of Pediatrics officially recommended universal predischarge risk assessment for severe neonatal hyperbilirubinemia with the goal of minimizing subsequent risk of chronic bilirubin encephalopathy (formerly known as kernicterus). In this article, we review recent research regarding jaundice predischarge risk assessment, current expert recommendations for universal predischarge bilirubin screening, and concerns expressed in the literature regarding these recommendations.
A group of experts have recently recommended universal predischarge bilirubin screening to identify newborns at risk for developing severe neonatal hyperbilirubinemia. In contrast, the United States Preventive Services Task Force states that there is insufficient evidence to make this recommendation. Transcutaneous bilirubinometry has emerged as a noninvasive, quick method to screen for neonatal hyperbilirubinemia, although refinement and validation of transcutaneous bilirubin nomograms are needed. Newer studies suggest that the combined use of a predischarge bilirubin and gestational age risk assessment offers a simple, objective, and accurate way to identify infants at risk for subsequent, severe hyperbilirubinemia.
All newborns should be systematically assessed for risk of developing severe hyperbilirubinemia prior to hospital discharge. Although limited data exist to recommend its use universally, predischarge bilirubin screening should be considered given recent expert opinion. The role of transcutaneous bilirubinometry remains promising, although further research evaluating and validating its use in varied and diverse populations is imperative. Combined models of risk assessment may offer the best approach to identifying infants at risk for subsequent, severe hyperbilirubinemia.
"Infant bilirubin that increases in the fi rst 24 hours, refuses to drop, or has no obvious etiology should be suspected of pathology (Colletti et al., 2007) such as maternal–fetal ABO/Rh incompatibility (Maisels, 2006; Preer & Philipp, 379 on VaB (Bhutani, Vilms, & Hamerman-Johnson, 2010; Lease & Whalen, 2010). However, AAP (2004) guidelines still recognize use of VaB in jaundice detection. "
[Show abstract][Hide abstract] ABSTRACT: "Common" neonatal jaundice can lead to dangerous levels of hyperbilirubinemia, causing neurological damage and even death. This article outlines evidence-based assessment techniques, management guidelines, and treatments for neonatal hyperbilirubinemia, addressing complexities that have arisen with new technologies and research results. We also explicate the role of the nurse in both prevention and care of patients and families who are affected by hyperbilirubinemia and jaundice.
MCN. The American journal of maternal child nursing 11/2013; 38(6):377-82. DOI:10.1097/NMC.0b013e3182a1fb7a · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Care of the NewbornWhoever says “all newborns look alike” has not been in a nursery for more than a few minutes. Each newborn has their unique physical features and personalities from day 1. A few things are common to newborns of all types, shapes, and sizes but there are a lot of natural variations and findings of interest. This chapter will attempt to serve as a guide in the general medical care of these young patients.Newborn HistoryCare of the newborn starts in the form of a complete history and physical. However, the newborn’s history is really one of the mother’s and the pregnancy. Even in the developed world, obtaining this accurate history can be complicated by the inconsistent transmission of data from the chart of one patient (the mother) in the outpatient setting to that of another (the newborn) in the inpatient setting. But due diligence is necessary to fully assess the newborn and to provide effective preventative care.Maternal History ...
Textbook of Clinical Pediatrics, 01/2012: pages 137-158; , ISBN: 978-3-642-02201-2
[Show abstract][Hide abstract] ABSTRACT: To describe primary care management of early and prolonged jaundice in otherwise-healthy term infants to identify opportunities to increase early diagnosis of cholestasis.
Community-based pediatricians in St Louis, Missouri completed a mailed, anonymous, 29-item survey to assess practice demographics, timing of routine newborn office visits, and the management of early and prolonged neonatal jaundice.
A total of 108 of 230 (47%) of eligible physicians responded (mean years in practice, 15.3, SD, 9.4). More respondents were very familiar with national guidelines for management of early (49%) than prolonged (16%) neonatal jaundice. Eighty-six percent reported all newborns were checked with transcutaneous bilirubin before hospital discharge. For transcutaneous bilirubin results at 48 hours of 7, 10, 12 and 15 mg/dL, 1%, 26%, 70%, and 74% of respondents, respectively, would order a fractionated bilirubin. Although the first routine visit usually occurred in the first week after discharge, 25% of physicians reported the 2nd visit was routinely scheduled after 4 weeks of age. Ninety-four percent reported they would obtain a fractionated bilirubin for infants jaundiced beyond 4 weeks of age. If cholestasis was identified at 6 weeks of age, 32% would obtain additional testing without referral to a subspecialist.
Management of early and prolonged neonatal jaundice is variable. Current practices appear to miss opportunities for early diagnosis of cholestasis and referral that are unlikely to be addressed without redesigning systems of care.
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