Neonatal Hyperbilirubinemia Protocol ***Place Protocol in Orders Section of the Chart****

Assessment of Hyperbilirubinemia (Jaundice) 0-24 hours of age • Visual assessment every 8-12 hours • Obtain Transcutaneous Bili Reading (TcB) at 24 hours or sooner for clinical signs of jaundice • Obtain serum bilirubin level if ≥ 6 @ 24 hours • Plot serum value on BiliTool at www.bilitool.org, evaluate threshold for phototherapy • Notify physician or NNP if result in high intermediate risk zone or higher • Document in newborns electronic record 24-72 hours of age • Visual assessment every 8-12 hours • Obtain Transcutaneous Bili Readings every 24 hours or sooner for clinical signs of jaundice • Obtain serum bilirubin level if ≥ 8 @ 36 hours ≥ 9 @ 48 hours ≥ 11 @ 72 hours, . Plot serum value on BiliTool at www.bilitool.org evaluate threshold for phototherapy • Notify physician or NNP if result in high intermediate risk zone or higher • Document in newborns electronic record Discharge • Obtain TcB just prior to discharge or as directed by physician or NNP • Document in newborns electronic record Newborn with Positive Direct Coombs Test • For Maternal blood type of “O” or an Rh of “Neg”, send newborn cord blood (purple top and red top) for “blood type” and “Direct Coombs” testing STAT • If cord blood unavailable collect specimen (purple bullet) for “blood type” and “Direct Coombs and send to lab STAT o If Coombs test is positive: Cord blood bilirubin reflex order will automatically generate. The lab will run the bilirubin STAT from the red top cord blood tube. o “total bilirubin cord blood” STAT will be drawn by lab o NOTE: The reflex order is only for cord blood specimens. If heelstick direct coombs was done (bc cord blood was unavailable) then nursery will have to order and collect a bilirubin by heelstick if indicated. o Notify physician or NNP within 2 hours of birth with cord bilirubin results as follows: . If cord bili level ≥ 3, consult Neonatology . If cord bili level ≥ 4, begin intense phototherapy and transfer to Neonatology Service and Special Care Nursery o Obtain Hct, Retic Count, Total, and Direct bilirubin at 6 hours of age, and notify physician or NNP of results within one hour of receiving results • Start phototherapy if ≥ 5 @ 6 hours ≥ 6 @ 12 hours ≥ 7 @ 18 hours ≥ 8 @ 24 hours

o Obtain serum bilirubin levels every 6 hours for 24 hours or as ordered by physician or NNP o Document in newborns electronic medical record

Special Considerations: . Any serum bilirubin level of greater than 25mg/dl is an emergency . DO NOT perform transcutaneous bilirubin (TcB) if infant on or has been on phototherapy. . Frequent feeding, 8-12 feeding per 24 hour period, supplement as needed or ordered . Monitor Intake & Output

Implemented by: ______, RN Date: ____/____/____ Time: ______

Origin: 6/15

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