Bilirubin levels? 36week baby

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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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    Usually do a TC Bili every 24 hours unless the baby was symptomatic; yes a bruise like a caput or something would increase risk of jaundice....think about why jaundice occurs. Also, if the baby is at risk of jaundice the ped usually sees them 1-2 days after discharge from PP.
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    We also go by weight for light levels, if the baby weighs 2400gm then 12 is the light level. There is a curve they use for the rate of rise at 24 hours on kids 35 weeks and older. Was the baby a set up for ABO or Rh? That will also figure into the rate of rise. If the baby is a set up,esp if not eating well, we would check another bili in 12 hours. If the baby is not a set up, then 24 hours. We would also have the mom putting the baby to breast every 2 hours and making sure that baby has good wet diapers.

    A small bruise isn't going to make the bili rise, but a caput or cephalohematoma or multiple bruises from birth will cause it to rise a bit faster.
    Elvish likes this.
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    Where I work, we typically will do a TCB on the baby at 24 hours of age, then at two days old, and three days old (if they are still an inpatient). If the Transcutaneous Bilirubin falls in the High Intermediate Risk Zone or the High Risk Zone, we will follow up with a serum bilirubin. We will treat the levels based on the serum, and we have found that our scanners run anywhere from 3-5 points higher than the serum levels.

    We have a bedside chart graph for the levels for all of our babies, but we also use Bilitool.org to plot our levels. It gives you the threshold for starting photo therapy based on baby's age and risk factors.

    Most pediatricians where I work will have a follow-up in 1-2 days after discharge if a baby had elevated levels just for a color check, and if the baby needs it, they will send them to the hospital for a bilirubin to be drawn. If the baby has issues with breastfeeding, they will also see them sooner than the typical two week follow-up.

    Infant's with major bruising, cephalohematomas, poor breastfeeders, ABO incompatibility, RH incompatibility, coombs positive babies, preemies, and sick babies are watched closely for elevated bilirubin levels.
    Jolie likes this.
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    Thanks for the replies! I'm glad they check bilirubin again. I felt like just checking bilirubin @ 24hrs wasnt enough....makes sense to check at 48hrs too. My pt was a vaginal delivery so she would be there for at least 48hrs b4 going home.
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    Was baby DAT negative or positive?
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    I'm not sure what DAT pos or neg means?
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    DAT pos or neg is referring to the direct coombs testing. a positive DAT increases the risk of elevated bilirubin levels. check Google or your nursing textbook to read about coombs testing. Always good to research and learn.


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