Approach To The Management Of Hyperbilirubinemia In Term
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Approach To The Management Of Hyperbilirubinemia In Term
- 1. Approach to the management of Hyperbilirubinemia in Term Newborn Infant Mohammadh Khassawneh MD
- 4. Bilirubin Production & Metabolism
- 7. Physiologic Jaundice Asian infant Breastfed infant Non-breastfed infant
- 10. Mechanism of Physiologic Jaundice Increased rbc’s Shortened rbc lifespan Immature hepatic uptake & conjugation Increased enterohepatic Circulation
- 22. 2004 AAP Guidelines Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia Pediatrics 2004; 114;297-316
- 26. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Nomogram for designation of risk in 2840 well newborns at 36 or more weeks' gestational age with birth weight of 2000 g or more or 35 or more weeks' gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values
- 30. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Algorithm for the management of jaundice in the newborn nursery
- 33. Copyright ©2004 American Academy of Pediatrics Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316 Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation
- 43. QUESTIONS?
Editor's Notes
- Jaundice < 24 hours = pathologic; check TSB or TcB Jaundice appears excessive for age = TSB or TcB The need for and timing of a repeat bili depends on the zone in which TSB falls, age of infant Interpret all bili levels according to infant’s age in hours
- Use total bili Risk factors = isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin < 3.0 Can use home phototherapy if no risk factors Based on limited evidence Use intensive phototherapy when TSB exceeds line If TSB doesn’t decrease or rises strongly suggests hemolysis If TSB > 25 or at level recommending exchange transfusion it is a med emergency and requires admission Isoimmune hemolytic disease: IV gamma globulin (.50-1 g/kg over 2 hrs) if TSB rising on phototherapy or within 2-3 mg/dL of exchange transfusion recommendations. Can repeat dose in 12 hours. Shown to decrease need for exchange transfusion