Neonatal Jaundice Management
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Questions and Answers

How often should mothers feed their babies in the first several days?

  • 3-4 hourly (correct)
  • 8-10 hourly
  • 2-3 hourly
  • 12 hourly

    • Formula is always added to breastfeeding to increase the infant's enteral intake.

    False

    What is the purpose of using transcutaneous bilirubinometry (TcB)?

    To screen and determine the need for serum bilirubin (SBR) testing in babies.

    Babies who are at risk for dehydration due to inadequate intake can be identified by assessing the adequacy of _______________________.

    <p>intake/output</p> Signup and view all the answers

    What is a sign of adequate intake in a breastfed baby?

    <p>4-6 wet nappies in 24 hours</p> Signup and view all the answers

    TcB can be used as a stand-alone device for diagnosis and management of hyperbilirubinaemia.

    <p>False</p> Signup and view all the answers

    Match the following criteria with when to use TcB:

    <p>Baby more than 35 weeks gestation, more than 24 hours old, and not receiving phototherapy = Use TcB for screening Baby with visible jaundice less than 24 hours after birth = Measure SBR and refer to Neonatal Team urgently Baby more than 35 weeks gestation, not visibly jaundice at the time of newborn screening test = Use TcB for screening</p> Signup and view all the answers

    A change from meconium to a _______________________ stool indicates adequate intake in a breastfed baby.

    <p>mustard yellow, pasty</p> Signup and view all the answers

    What is the purpose of the guidelines provided in the management of neonatal jaundice?

    <p>To provide medical and nursing staff with guidelines in the management of neonatal jaundice.</p> Signup and view all the answers

    The Neonatal Registrar will review all babies who are visibly jaundiced within the first 48 hours of life.

    <p>False</p> Signup and view all the answers

    What is the importance of recognising babies with pathological jaundice early?

    <p>To prevent serious hyperbilirubinaemia, prevent acute bilirubin encephalopathy and subsequent kernicterus, prevent exchange transfusion, minimise separation of mothers and babies, and support breast-feeding.</p> Signup and view all the answers

    SBR stands for _______________________ Bilirubin.

    <p>Serum</p> Signup and view all the answers

    Match the following risk factors for severe hyperbilirubinaemia with their classification:

    <p>Jaundice observed in the first 24 hours of life = Major risk factor Previous sibling requiring phototherapy = Minor risk factor Gestational age &lt;35 weeks = Not a risk factor Macrosomic infant of a diabetic mother = Minor risk factor</p> Signup and view all the answers

    Visual estimation of bilirubin levels is always accurate in babies with darker skin tone.

    <p>False</p> Signup and view all the answers

    What is the recommended setting for visual assessment of jaundice?

    <p>In a bright and natural light setting.</p> Signup and view all the answers

    What is the first area of the body where jaundice appears?

    <p>The face</p> Signup and view all the answers

    Study Notes

    Purpose and Scope

    • The purpose of the guidelines is to provide medical and nursing staff with management guidelines for neonatal jaundice.
    • All babies developing jaundice must be evaluated in a timely manner.

    Definitions

    • SBR: Serum Bilirubin
    • TcB: Transcutaneous Bilirubinometry

    Procedure: Severe Hyperbilirubinaemia in Newborn Babies

    • Major risk factors: • Jaundice observed in the first 24 hours of life • Gestational age <35 weeks or 10% weight loss compared to birth weight • Sepsis
    • Minor risk factors: • High pre-discharge serum bilirubin (SBR) or Transcutaneous Bilirubinometry (TcB) level • Jaundice observed before discharge • Previous sibling requiring phototherapy • Macrosomic infant of a diabetic mother

    Nursing Assessment for Jaundice

    • Visual Assessment: • Assess the baby in a bright and natural light setting • Assess the sclerae, gums, and blanch the baby's skin to observe the underlying skin color • Jaundice appears first in the face and progresses caudally to the trunk and extremities
    • Visual estimation of bilirubin levels can lead to errors, especially in babies with darker skin tone, who are preterm, under 24 hours of age, or receiving phototherapy

    Other Assessment

    • Assess baby's feeding regime and adequacy of intake
    • Advise mothers to feed their babies at least 3-4 hourly or 8-12 times per day for the first several days
    • Increasing the frequency of feeds decreases the likelihood of subsequent significant hyperbilirubinaemia
    • Assess adequacy of intake/output, including: • 4-6 wet nappies in 24 hours and the passage of 3-4 stools per day by day 4 of life • A change from meconium to a mustard yellow, pasty stool

    Use of Transcutaneous Bilirubinometry (TcB)

    • Principles: • TcB can be used to screen and determine the need for SBR testing in:
      • Babies >35 weeks gestation, >24 hours old, and not receiving phototherapy
      • All babies >35 weeks gestation, not visibly jaundiced at the time of their newborn screening test • This device is NOT intended as a stand-alone device for diagnosis and management of hyperbilirubinaemia.

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    Description

    Guidelines for medical and nursing staff on managing neonatal jaundice, including timely evaluation and prevention of serious complications. Covers recognition and prevention of hyperbilirubinaemia, acute bilirubin encephalopathy, and kernicterus.

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