<p> Resident information about neonatal hyperbilirbinemia </p><p>Major Risk factors:</p><p> Pre-discharge Bilirubin level in the high-risk zone on the bilirubin chart  Blood group incompatibility with positive direct anti-globulin test  Hemolytic disease (G6PD, spherocytosis )  Gestational age <37 weeks  Previous sibling received phototherapy  Cephalohematoma or significant bruising  Exclusive breastfeeding (particularly if nursing is not going well and weight loss is excessive)  East Asian race</p><p>Minor risk factors: </p><p> Macrosomia  Infant of a Diabetic mother  Maternal age 25 y  Male gender  Pre-discharge TSB or TcB level in the high intermediate-risk zone  Gestational age 37–38 wk  Jaundice observed before discharge  Previous sibling with jaundice </p><p>For any newborn who is jaundiced at less then 24 hours of age obtain:</p><p> Serum Bilirubin Level (total and direct)  Maternal Blood Type (look for isoimmune antibodies, Rh incompatibility)  Infants Cord Blood Type (look at Rh and look for DAT +)  CBC with manual differential  Reticulocyte count</p><p>**Determination of the rate of rise of TSB and the infant's age may help determine how often to monitor bilirubin levels and whether to begin photo- therapy. (rate of rise calculated using 2 specimens drawn at a given # hrs apart)</p><p>**Continued observation may be an appropriate alternative to repeated TSB testing and phototherapy.</p><p>Phototherapy</p><p> Minimum evaluation and documentation must include the infant’s age, maternal history, physical exam, total serum bilirubin and the rate of rise.</p><p> Phototherapy should produce a decline in the total bilirubin level of 1 to 2 mg/dL within 4 to 6 hours, and the decline should continue thereafter. I Exchange Transfusion </p><p>The goal is to prevent kernicterus. </p><p> If the total bilirubin level does not decline despite appropriate phototherapy, or is at or above a high level of risk on the phototherapy graph, exchange transfusion is recommended.</p><p> Intensive phototherapy is recommended while preparations are being made for exchange transfusion. o This will hopefully prevent further elevation of the bilirubin level. o If level then drops below exchange transfusion levels during preparation, the transfusion may be avoided. .  Failure of intensive phototherapy to lower the total bilirubin level strongly suggests the presence of hemolytic disease or some other pathologic process and warrants further investigation.</p><p>Phototherapy Guidelines for infants >35weeks gestation from www. AAP.org Additional References:</p><p>Jaundice in a newborn: Answers to questions about a common clinical problem. First of two parts. http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=161376</p><p>Jaundice in a newborn: How to head off an urgent situation. Second of two parts. http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=161378</p><p>Treating acute bilirubin encephalopathy--before it's too late http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=161379</p>