Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by dawngloves

It's interesting you say that because all of our high bilirubin babies have come from the newborn nursery. Mostly kids with a 12 hour bili of 15 because of hemolytic anemia.

We see things like prematurity (between 34 and 37 weeks), ABO incompatibility, large cephalohematoma or excessive bruising, poor breastfeeding with no supps allowed, fever. Or any combination of the above.

All of our kids who aren't already scheduled for a serum bili level get a BiliChek on their second day as a screening tool. For those not familiar with the term, that's a non-invasive light meter test done on the forehead. It can be done whenever we think a baby looks too yellow or ruddy. We check the results against the Bhutani graph that factors in the level we get against the age of the baby (in hours).

If a nurse thinks a baby needs a level apart from that second day reading, she can do a BiliChek at any time. Nurses can order serum bili levels, too. We've made a number of good catches that allowed a child to start treatment quickly.

The hospital where two of my daughters just had their babies does not do routine screening. And nurses can't order serum bili levels, only the docs. We specifically had to ask for a level for the wee one born in August, even though he had three risk factors--ABO incompatibility, cephalohematoma, and exclusive breastfeeding, and he looked jaundiced. His level was in the moderate risk range, but he was monitored closely after leaving the hospital and he was all right. It did bother me (and his nurse), though, that the doc (covering for their regular ped) had to be asked for a serum bili.

With all the monitoring tools we have and our ability to treat high bilirubin levels aggressively, kernicterus is a condition that just shouldn't happen.

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by rn/writer

With all the monitoring tools we have and our ability to treat high bilirubin levels aggressively, kernicterus is a condition that just shouldn't happen.

Miranda, you're right. And thankfully, it is very rare. I've only seen one (presumed) case in 11 years, but what made it so terribly tragic was that it should have been prevented.

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by lvnurs9

We got called to Peds for a 2 day old whos bili was 24 or something. The kid was dehydrated like no other and was a home birth. After a million lab draws and one IV gone bad, the parents said they would rather their baby die then to get poked again so the Peds let them take her home. I nearly threw up after being told that.

I would have called CPS!

Re: What is the Highest Bilirubin you've ever seen?

Apparently the peds didn't care enough to argue. He discharged the baby... I would love to know if she is still even alive or if she died of dehydration.

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by lvnurs9

We got called to Peds for a 2 day old whos bili was 24 or something. The kid was dehydrated like no other and was a home birth. After a million lab draws and one IV gone bad, the parents said they would rather their baby die then to get poked again so the Peds let them take her home. I nearly threw up after being told that.

i think there are legal avenues healthcare providers can take if they feel the need. i'm suprised the peds let her do that - always amazes me.

Re: What is the Highest Bilirubin you've ever seen?

normal bili levels are dependant on age (in terms of hours/days), gestational age, and institutional values. I know this isn't really the answer that you want to hear, but in general a full term healthy baby should be less than 10 at 24 hours of age. If it is 10 or higher, you usually need phototherapy and further investigation

Re: What is the Highest Bilirubin you've ever seen?

I'm also a big fan of nurses understanding and recognizing ABO incompatibility. Not every resident is going to pick up on it, and we find out later when the kid turns into a pumpkin and has no cord stump for an exchange transfusion.

Re: What is the Highest Bilirubin you've ever seen?

My father is currently in hospital with bilirubin level over 400. Does anyone know how high it can go

Re: What is the Highest Bilirubin you've ever seen?

Originally Posted by jeepgirl

i think there are legal avenues healthcare providers can take if they feel the need. i'm suprised the peds let her do that - always amazes me.

There is, it is called "chain of command." If you don't feel the order of the physician is appropriate, go up the ladder per your hospital policy. As nurses, we are the patient's advocate and it sounded like this baby needed one.

Re: What is the Highest Bilirubin you've ever seen?

40 yes I said 40!!!!!!!!!!