Bilirubin levels ?

Specialties NICU

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I just finished my postpartum rotation. We had a 36 week old baby with a trancutaneous bilirubin reading of 7.0 @ 24hours (nurse told me 7.0 was higher than they would like to see for a baby at this age). A serum bili was ordered and it came back at 6.3 so the doctor did not order any interventions....Since the baby was a premature baby, and at 6.3 serum bili, would they order another bilirubin reading to make sure it's not rising before the baby leaves the hospital? Or do they only check it at 24hrs?

If the baby was bumped, after the 24hr bilirubin was checked, and had gotten a bruise, would that raise baby's bilirubin to a point that it could be very severe/life threatening?

The baby was having troubles with breastfeeding as well. Do they check levels a few days after the baby goes home? I'm so confused because jaundice is so common, especially in a premature baby, with breastfeeding issues. I wonder how often they do checks to make sure that the levels are not rising?? Anyone able to fill me in? Thanks!!

Lot's of questions.. :)

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.

7.0 and 6.3 is elevated for 24 hours of age, but phototherapy usually isn't started until 10.0 (in most cases, depending on the doc). Prematurity increases the risk of hyperbilirubinemia as the liver in a preemie is even more immature than that of a term kid. Dehydration will increase serum bill level. If the baby is not nursing well and not receiving supplemental formula, the baby is not peeing or pooping out the bill as that is how it is excreted from the body.

Bruising from birth trauma will increase the bilirubin level as the blood is reabsorbed from the bruises, but it shouldn't be to life threatening levels (>20.0).

If there is a concern about the bill, esp with prematurity and breastfeeding only, they should check another bill before discharge. If that bill is elevated, the pediatrician will do a follow up bill at the baby's first pediatrician visit in the office.

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Specializes in L/D 4 yrs & Level 3 NICU 22 yrs.

Definitely follow up with pediatrician and lactation within a few days of discharge.

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Specializes in Neonatal ICU (Cardiothoracic).

I would also be interested in the mom and baby's type and coombs results. An ABO reaction will cause the bili to rise more quickly, and higher, and will probably require lights. I would check one more bili before sending the baby home, to be check by the pediatrician the following day. Things to monitor would be feeding success and I/Os.

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