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Neonatal Jaundice Inpatient Algorithm

Neonatal Jaundice Inpatient Algorithm - 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
POST NEWBORN DISCHARGE AFCH INPATIENT
GENERAL CARE ALGORITHM
Patient Admitted
Inpatient Management
ξ If direct admit, obtain baseline total bilirubin with conjugated fraction (if not already completed).
Consider RN heel stick.
ξ Place in giraffe warmer.
ξ Place under phototherapy as soon as possible (goal < 60 minutes from admission)
ξ Continue effective phototherapy until total bilirubin at least 3 mg/dL below phototherapy threshold.
ξ Encourage feeding. The infant should not be removed from bili lights for > 20 minutes in an 3 hour
period. Use bottle if needed. If mild dehydration or weight loss > 10% from birth weight and not
feeding well, consider NG feedings.
ξ Consider IV fluids for patients not tolerating enteral feeds or with ongoing cardiovascular signs of
dehydration.
Patient meets NICU
Consult Criteria?*
ξ Measure total bilirubin

every 4 hours until total
bilirubin falling.
ξ Measure G6PD (for

unexplained hemolysis)
Yes
Measure total bilirubin 4-6
hours after starting
phototherapy (or with
routine AM labs)
No
Total
bilirubin below
phototherapy
threshold?
Discharge
Confirm the following:
- Follow-up appointment scheduled for next day
- No concern for significant ongoing hemolysis

-

Patient feeding well
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
NOTE: Supplemental IV fluids
or IV placement are NOT
routinely indicated.
Exclusion Criteria:
* Direct hyperbilirubinemia
* Suspected sepsis or ill-appearing
* Meets NICU Direct Admit Criteria
Criteria for NICU
Transfer:
-

Signs of moderate-
severe acute bilirubin
encephalopathy
-

Total bilirubin > 2 mg/
dL above exchange

transfusion threshold
*NICU Consult Criteria:
-

Total bilirubin within 2
mg/dL of exchange

transfusion threshold
-

High suspicion for or
lab evidence of
hemolysis

(i.e., DAT positive)
-

Concerning vital signs
(i.e., apnea > 20 sec.,

bradycardia < 100 bpm,
frequent O2 sat. < 90%)
-

If patient still requires
hospitalization after 48
hours
**Indications for rebound
total bilirubin measurements:
-

Slow resolution of

hyperbilirubinemia with
phototherapy
-

Uncertainty regarding ability
for post discharge bilirubin
measurements
- Hemolysis suspectedIndications for
rebound total
bilirubin?**
Yes
Continue
phototherapy.
Measure total
bilirubin in 6-12
hours.
No
Measure total
bilirubin for
rebound.
Yes
No
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 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