Hyperbilirubinemia

[roseycrest]

Re hyperbilirubinemia:

Hi All,

This is an area that seems to be changing. Asking others on a regular pedi unit, how they handle an infant ( in the first week of life) that comes in for treatment of hyperbilirubinemia? We rarely see this infant now but it seems there have been some changes in the hospital management.

Thanks for your help.

[prmenrs, RN]

This is a neonatal dx!! What's it doing on peds?

Anyway, now that it's there...HYDRATE, and bili lights, once you're sure it's a high INdirect bili, not direct. They often get a septic w/u and antibiotics as well. Encourage stooling, usually not a problem once they're rehydrated. They should be in an incubator because you take off their clothes under the bili lights (newborns can get cold stressed), and don't forget to cover their eyes.

If it's a high DIRECT bili, a cause needs to be found. You can soemtimes get it lower w/phenobarb and/or actigall [ursodiol], but determining the cause is critical.

If the baby is breast fed, mom may be having problems w/milk supply and adequate hydration [for herself], so she should have a lactation consult. She MUST keep pumping q 3-4 hrs AROUND THE CLOCK (rent her an electric pump and use a double set-up if possible), and she should be allowed to stay w/the baby.

Sometimes a 24 hr rest from breast feeding/milk is ordered to r/o true breast milk jaundice, which is rare. We feed babies who, for whatever reason, can't go to breast, Nutramegen, which is so disgusting they can't wait to go back to mom. I also like Lactofree for these babies, especially if they get diarrhea after a day or two on antibiotics and under the bili light.

Check Merenstein and Gardner's book for more info--I like their explanation best.

This wouldn't be too much info, would it?

[OBNURSEHEATHER]

So what the heck does the TOTAL bili represent? At my hospital the order is always the same... total & direct. We never do an indirect.

Or is it something really silly and obvious like Total - direct = indirect?

Hehe! That would be the kind of question I'd ask!

Heather

[prmenrs, RN]

you figured it out!! I knew you would!

[Jolie, BSN]

Marlene,

Most babies with hyperbili are treated with home phototherapy now, unless their bili's are dangerously high, making them candidates for exchange transfusion. At home, they are set up with fiberoptic phototherapy units like the Wallaby. These devices wrap around the baby's body like a blanket, eliminating the need for eye patches, and enabling the baby to be handled with relative ease for feeding, cuddling, etc. Most insurance companies will allow at least 1 home nursing visit a day to assess the baby and draw a bili level, as this is much cheaper than hospitilization. My youngest was treated this way, and it was far preferable to returning to the hospital!

[nurs4kids]

Prmenrs said it all. Ours do not routinely go to NI(we reserve NI for vents & ECMO), nor are they in an isolet, unless they're incapable of maintaining their body temp. We uncloth them under the lights and then cover and wrap them, just as you would any baby, when not under the lights. We also use the Wallaby's on occassion (don't own them, so have to rent them). The biggest portion of our kids are treated at home, not in the hospital.

[dawngloves, BSN, RN]

While on the subject, what are parameters for bili for term babies? Both my kids had hyperbili (36 week 7 pound daughter discharged with total 14) and were sent home with instructions to "put them in a sunny spot" and trek to the hospital for daily labs.

Is this a common practice? I sure don't see that with 32 weekers.

[prmenrs, RN]

It depends on the age of the baby, gestation, and the total bili value. The other factor is blood incompatibilities.

If you can find a "Harriet Lane", I think there is a graph in there that gives the critical values--when to light, and when to exchange.

[OBNURSEHEATHER]

Doesn't it also depend on type of feedings (breast vs. bottle)?

Heather

[dawngloves, BSN, RN]

Is "Harriet Lane" the book from Johns Hopkins? I think I've seen it laying around the unit and have been meaning to investigate it. Thanks!

[prmenrs, RN]

That's the one.

They are less likely to become dehydrated and develope a hi bili if they are bottle/formula fed, but I'd MUCH, MUCH rather see them get breast milk. Hydrate the MOTHER!! There is a true breast milk juandice, but it is very rare.

If they have a lot of bruising, they can get high bilis, and I've never met a premie that didn't need to get lit!

[live4today, RN]

Hi prmenrs:

When I worked pedi in a military hospital, if a baby needed to be treated for hyperbili..., the baby was transferred from the nursery to the pedi unit. Probably because of bed space, I'd imagine. At that time, there was no Neonatal unit for sickies, only peds. We took care of newborns to age 15 year olds on pedi. If the newborn went home, then needed to be readmitted for hyperbili... treatment, they were also admitted to pedi unit. This may be why that particular hospital admitted the baby on the pedi unit (?) :)