Neonatal Jaundice Follow-up

Updated: Dec 27, 2017
  • Author: Thor WR Hansen, MD, PhD, MHA, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Follow-up

Further Inpatient Care

Infants who have been treated for neonatal 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.

The 2004 AAP guideline recommends a systematic risk assessment for hyperbilirubinemia risk in all infants before discharge. [40] Parents should be provided with verbal and written information about jaundice.

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Transfer

Infants in need of exchange transfusion born at or admitted to facilities not capable of performing this procedure should be transferred to the nearest facility with such capability. In addition to complete records, the infant should be accompanied by a sample of maternal blood because this is needed by the blood bank to match blood.

However, in determining the best use of time before transfer, as well as the timing of the transfer, the following factors should be considered:

  • If the infant is in imminent danger of kernicterus, or is already exhibiting signs of neurological compromise, the most efficient phototherapy possible under the circumstances should be immediately initiated and should be continued until transfer commences. If fiberoptic or any other kind of phototherapy is technically feasible during transport, it should be continued throughout the duration of the transport.

  • If the hyperbilirubinemia is due to blood group isoimmunization, an infusion of intravenous immunoglobulin (IVIG) at 500 mg/kg should be immediately started and continued before and during transfer until completed (2 h).

Even if the receiving hospital determines that an exchange transfusion should be performed, continuing optimal phototherapy until the actual exchange procedure can commence is important. If fiberoptic phototherapy is available, the infant may be left on a fiberoptic mattress while the exchange is carried out. Oral hydration with a breast milk substitute may aid the clearance of bilirubin from the gut, thus inhibiting enterohepatic circulation of bilirubin, and should be given unless clearly contraindicated by the clinical state of the infant. Although none of these suggestions have been tested in randomized controlled trials, case reports, bilirubin photobiology, and expert opinion suggest that they may be beneficial and, at the very least, are unlikely to be harmful.

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