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Emergency Dept. Algorithm for Neonatal Jaundice

Emergency Dept. Algorithm for Neonatal Jaundice - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Neonatology, Related


Neonatal Jaundice for Infants > 35 Weeks Gestational Age
EMERGENCY DEPARTMENT ALGORITHM
Patient Presentation
Last revised: 06/2015
Last reviewed: 06/2015
Contact CCKM for revisions.
Neonatal Jaundice – Neonatal – Inpatient/Ambulatory Clinical Practice Guideline
Inclusion Criteria:
* Well appearing
* Age < 14 days
* Born at > 35 weeks gestational age
* Concern for jaundice
Perform Initial Assessment including:
ξ Blood glucose if indicated
ξ Total bilirubin with conjugated fraction. Consider heel stick.
ξ If high risk for hemolysis*, consider obtaining a CBC without differential, blood type and
screen, direct antibody test or direct Coomb’s test, or reticulocyte count.
ξ Determine exchange transfusion threshold using AAP nomogram and phototherapy threshold.
NOTE: Supplemental IV fluids NOT routinely
indicated. Consider formula supplementation
or NG feedings if not eating well.
Admit to General Care
Ongoing ED Management
ξ Encourage feeding, however the infant should not be removed from bili lights for > 20 minutes in any 3 hour period. Use
bottle if needed. Consider NG tube.
ξ Do NOT interrupt phototherapy for patients nearing exchange transfusion threshold or with rapidly rising total bilirubin
ξ Use maternal EBM for supplemental feeds, if indicated.
ξ Consider 20 mL/kg NS bolus and maintenance IV fluids for patients that meet NICU Consult Criteria or show
cardiovascular compromise due to dehydration.
ξ If available, initiate phototherapy while waiting for admission.
Exclusion Criteria:
* Direct hyperbilirubinemia
* Suspected sepsis or ill-appearing
* Meets NICU Direct Admit Criteria
STEP 4
Automatic NICU Admission Criteria
ξ Signs of moderate-severe acute

bilirubin encephalopathy or total

bilirubin > 2 mg/dL above exchange
transfusion threshold
STEP 1
Evaluate for Discharge from ED
ξ Total bilirubin below phototherapy
threshold
ξ Follow-up appointment arranged for
next day
ξ Feeding adequately
ξ No concern for significant hemolysis
STEP 3
Evaluate for NICU Consult Criteria
ξ Total bilirubin within 2 mg/dL of
exchange transfusion threshold
ξ Age < 24 hours
ξ High suspicion for or lab evidence
of hemolysis (i.e., DAT positive)
ξ History of NICU admission or stay
STEP 2
Evaluate for Inpatient Admission
ξ Total bilirubin above phototherapy

threshold but not within 2 mg/dL of
exchange transfusion threshold

(i.e., at 72 hours of age, exchange

transfusion threshold 24 and total
bilirubin 21)
ξ Consider phone consultations with
patient's primary care physician to
determine if appropriate for
outpatient management
Admit to NICU
(Outside guideline scope)
Discharge from ED
Acuity
warrants admission
as determined by
NICU attending
physician?
No
Yes
*Risk factors for hemolysis:
ξ Family history of G6PD or

other hemolytic disorders
ξ Maternal blood type O
ξ Patient age < 24 hours
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:CCKM@uwhealth.org 06/2015

Last revised/reviewed: 06/2015 | Contact CCKM for revisions.
Neonatal Jaundice – Neonatal – Inpatient/Ambulatory Clinical Practice Guideline
Reference: Hyperbilirubinemia AAoPSo. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297- 316.
Figure 1. Exchange Transfusion in Infants > 35 weeks' gestation
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2015CCKM@uwhealth.org

Last revised/reviewed: 06/2015 | Contact CCKM for revisions.
Neonatal Jaundice – Neonatal – Inpatient/Ambulatory Clinical Practice Guideline
Reference: Hyperbilirubinemia AAoPSo. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297- 316.
Figure 2. Phototherapy Thresholds in Infants > 35 weeks' gestation
Copyright © 2015 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2015CCKM@uwhealth.org