Pediatrics A Competency-Based Companion: With STUDENT CONSULT Online Access (Competency Based Companion) by McMahon Maureen C & Stryjewski Glenn R

Author:McMahon, Maureen C & Stryjewski, Glenn R [McMahon, Maureen C]
Language: eng
Format: epub, mobi
Publisher: Elsevier Health
Published: 2011-05-23T21:00:00+00:00

Figure 60-2 Guidelines for phototherapy in hospitalized infants of 35 or more weeks of gestation. (Reproduced with permission from AAP Clinical Practice Guideline. Subcommittee on Hyperbilirubinemia: Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114:297-316, 2004, Fig. 3, Copyright © 2004 by the AAP.)

History

• Consider gestational age. Late-preterm infants (35 to 37 weeks’ gestation) need close monitoring and are at risk because of immaturity of the liver and blood-brain barrier (see Chapter 59, The Late-Preterm Infant).

• Consider chronologic age. Jaundice within the first 24 hours of life is pathologic. In addition, a rate of rise greater than 0.5 mg/dL/hr is concerning for active hemolysis.

• Maternal blood type and antibody screen should be documented. For maternal group O or Rh-negative mothers, infants should have a blood type and direct antibody (Coombs test) sent to determine if there is a “setup” for hemolysis.

• Consider ethnicity. Individuals of Mediterranean, Middle Eastern, Southeast Asian, and African descent may have G6PD deficiency causing hemolysis.

• Babies of Southeast Asian descent may have higher bilirubin levels independent of other factors.

• Has a previous child required phototherapy?

• Have any family members had splenectomy or cholecystectomy to suggest hereditary spherocytosis?

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