Neonatal Hyperbilirubinemia 1 Bilirubin is produced by hemoglobin

Neonatal Hyperbilirubinemia 1 Bilirubin is produced by hemoglobin catabolism. Unconjugated bilirubin is carried in the blood to the liver where it is conjugated to glucoronic acid and excreted into bile. It can be reabsorbed in the digestive tract by enterohepatic circulation. Hyperbilirubinemia is common and may be normal in neonates; we monitor it to prevent neurotoxicity. It may be adaptive to help prevent bacterial infection. Non-pathologic causes of elevated bilirubin: -Benign neonatal hyperbilirubinemia: seen in the first week of life; due to high RBC turn over and immature liver cells. -Breast feeding jaundice: first week of life; low calorie intake and stool output lead to increased enterohepatic circulation. -Human milk jaundice: second week of life; breast milk contents inhibit bilirubin conjugation. Can last months. Pathologic: -Increased production: hemolytic disease, polycythemia, cephalohematoma -Impaired conjugation: Gilbert, Crigler-Najjar -Decreased bilirubin excretion: biliary atresia, Dubin-Johnson, Rotor syndrome -Infection: UTI, sepsis -Metabolic disorders: hypothyroidism, galatosemia Risk factors for quickly rising or severe hyperbilirubinemia: TSB in the “high risk zone” > 95 th percentile for age in hours TSB rate of rise > 0. 2 mg/d. L/h Jaundice in first 24 hours What is the relative Coombs test positive risk reduction of Cephalohematoma Sibling needing for light therapy statins primary Gestational age 35 -36 weeks of CVD Poorprevention feeding, weight loss Risk factors for developing neuro toxicity with hyperbilirubinemia: Isoimmune hemolytic disease G-6 -PD Deficiency Asphyxia Significant lethargy Temp instability Sepsis Acidosis Updated 4/20

Neonatal Hyperbilirubinemia 2 All babies in the MBU get a 24 hour TSB; TCB every morning thereafter. Use Bilitool to interpret the result (see right >): 1. Decide if the baby has neurotoxicity risk factors. 2. Using that and gestational age, determine their light level with bottom table; start lights if needed. 3. If lights are not needed, then decide if patient has a risk of developing high bilirubin or a high rate of rise (>0. 2 per hour increase). 4. Use that information and the gestational age to determine when to check next level. 5. Management Feeding: 8 -12 feeds per day; Do not need to interrupt breastfeeding or supplement soley for hyperbilirubinemia unless there is another indication to supplement. Phototherapy: order family-centered phototherapy or triple bank phototherapy • Consider TSB @ 4 -6 hours after starting lights and intensifying if TSB still rising, especially if Coombs+ • Repeat TSB @ ~12 -16 hours of lights. Stop lights when TSB is < 12 or has dropped by 5 points. Stopping too soon will lead to needing to re-start lights. • Do not re-check for rebound hyperbilirubinemia before discharge unless patient has hemolytic disease 3 4 2 1 Updated April 2020