Hyperbilirubinemia Web Meeting 2018 Dr. Ann Anderson Berry · screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. The Journal of Pediatrics,

Hyperbilirubinemia

Web Meeting

2018

Dr. Ann Anderson Berry

Introduction

Objective

• Describe evidence-based practices (EBP) to prevent

hyperbilirubinemia and kernicterus

• All newborns will have a prn bilirubin order (TSB or TCB) to

be initiated at the nurse’s discretion (AAP)

-Visual assessment not accurate (Keren)

AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:

10.1542/peds.114.1.297.

Keren, R., Luan, X., Friedman, S., Saddlemire, S., Cnaan, A., & Bhutani, V. K. (2008). A comparison of alternative risk-assessment strategies

for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics, 121(1), e170-9.

EBP

• Universal predischarge bilirubin screening-TSB or TcB

• Use of clinical risk factors and predischarge bili to predict risk

of hyperbilirubinemia

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in the newborn infant ≥ 35

weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198. DOI:10.1542/peds.2009-0329

Bhutani, V. K., Stark, A. R., Lazzeroni, L. C., Poland, R., Gourley, G. R., Kazmierczak, S., . . . Stevenson, D. K. (2013). Predischarge

screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. The Journal of Pediatrics, 162(3), 477-482.e1.

10.1016/j.jpeds.2012.08.022

EBP

AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.

Pediatrics, 114(1),297-316. DOI: 10.1542/peds.114.1.297.

Risk Factors

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

Risk Factors

• Use hour-specific nomogram to interpret bili (Maisels 2009, AAP 2004)

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te newborn infant ≥ 35

weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198. DOI:10.1542/peds.2009-0329

AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:

10.1542/peds.114.1.297.

EBP

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

www.bilitool.org

Recommendations for Management and Follow-up

EBP

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

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

Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te

newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.

DOI:10.1542/peds.2009-0329

Recommendations for Management and Follow-up

• Written and verbal info to parents at discharge explaining

jaundice and need to monitor for (AAP, 2004)

AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:

10.1542/peds.114.1.297.

EBP

SUMMARY

• TSB or TcB if any jaundice noted visually (AAP, Keren) to be initiated by the nurse (NANN 2010)

• Use of clinical risk factors and predischarge bili to predict risk of hyperbilirubinemia (Maisels)

• Universal predischarge bilirubin screening-TSB or TcB (Maisels)

• Use hour-specific nomogram to interpret bili (Maisels 2009, AAP 2004)

• Written and verbal info to parents at discharge explaining jaundice and need to monitor for (AAP 2004)

• Follow up post discharge per algorithm (Maisels 2009)

• G1P0

• 36 5/7 wks gestation

• Hispanic

• PROM

• Apgars 7 & 9

• AB pos

• SVD after 20 hour

labor with oxytocin

• Formula feeding

• Universal bili screen

at 24h with newborn

screen was 10.6

(TSB)

Case 1

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

G4P3

39 weeks

gestation

Caucasian

SVD after 2 hour

labor

O pos

Apgars 9 & 9

Breastfeeding well

Case 2

Post Discharge:

• ER visit 48 hours after discharge (72 hours of life) for poor

feeding – PE Jaundiced

• Bilirubin 24

Questions Can be

Directed to Peggy Brown

or Ann Anderson Berry

through NPQIC.org