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NEONATAL JAUNDICE FOLLOW-UP
Category: Child Health
Abstract : neonatal jaundice follow-up Further Inpatient Care: • Infants who have
been treated for jaundice can be discharged when they are feeding adequately and
have had 2 successive serum bilirubin levels demonstrating a trend towards lower
values. • If the hospital does not routinely screen newborns for auditory
function, ordering such tests prior to discharge is advisable in
neonatal jaundice follow-up
Further Inpatient Care:
• Infants who have
been treated for jaundice can be discharged when they are feeding adequately and
have had 2 successive serum bilirubin levels demonstrating a trend towards lower
values.
• If the hospital does not routinely screen newborns for auditory
function, ordering such tests prior to discharge is advisable in infants who
have had severe jaundice.
Further Outpatient Care:
• In the era of
early discharge, newborns released within the first 48 hours of life need to be
reassessed for jaundice within 1-2 days. Use of the hour-specific bilirubin
nomogram may assist in selecting infants with a high likelihood of developing
significant hyperbilirubinemia.
• Telephone consultations are not
recommended because parental reports cannot be gauged appropriately. In recent
years, a number of infants have developed kernicterus, resulting, at least in
part, from inadequate communication between physicians or their representatives
and parents.
• Availability of new devices for transcutaneous measurement
of bilirubin levels should facilitate follow-up evaluations of infants
discharged before 48 hours of life.
• Home phototherapy
o Home
phototherapy is used in an effort to limit the high cost of applying such
therapy in hospitals. Home treatment can avoid or limit parent-child separation.
Home treatment should be used with caution, since prevention of neurotoxicity is
the goal. Some physicians argue that an infant at risk for neurologic damage
should not be at home.
o With effective treatment strategies, the average
duration of phototherapy in the regular neonatal nursery at the author's
institution is less than 17 hours. Whether the effort and cost to set up home
therapy is worthwhile is debatable. This assessment may be different in
different socioeconomic and health financing circumstances.
• Infants who
have been treated for hemolytic jaundice require follow-up observation for
several weeks because hemoglobin levels may fall lower than seen in physiologic
anemia. Erythrocyte transfusions may be required if infants develop symptomatic
anemia.
Complications (neonatal jaundice):
•
Kernicterus
Prognosis (neonatal jaundice):
• Prognosis is excellent if
the patient receives treatment according to accepted guidelines.
• Brain
damage due to kernicterus remains a true risk, and the increased incidence of
kernicterus in recent years may be due to the misconception that jaundice in the
healthy full-term infant is not dangerous and can be
disregarded.
Medical/Legal Pitfalls (neonatal jaundice):
• Failure to
recognize the potential of significant jaundice to cause brain damage, even in
the healthy full-term neonate
• Failure to assess whether a full-term neonate
is both healthy and was delivered at term
• Failure of the physician to
personally examine an infant reported by parents or other caregivers to be
significantly jaundiced
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