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Discussion

Jaundice help!

I am usually good at knowing if a newborn has jaundice of the face, but I'm having a hard time with the body. I'm a home health nurse and now have to use my judgment about drawing bilirubins and I'm not sure when exactly to draw one, anyone have any opinions? If a baby had jaundice down to his belly would you draw one? Is there any tricks either to help with discerning it on the body?? I'm holding the baby in the natural sunlight to help but still having a hard time.

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    Touch their skin- if it blanches white it is not jaundice. If it looks yellow, then it is.

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    Jaundice doesn't demarcate. If their face is jaundiced their whole body is jaundiced. It's more noticable in their faces because we tend to look at their faces much more closely than we do their bodies and generally the skin is thinner. If you press the skin on their forehead with your finger and then look at the blanched spot, you'll see the yellowish coloration, as Gooey said. Do the same over their sternum and you'll see the same result.

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    I've been told by our physicians that the idea that it travels downward as it worsens is not current information. I think that belief may have come about because it is easier to note in the face/sclera and harder in the rest of the body but becomes more apparent as it worsens. The decision to draw a bili depends on your criteria from your agency, but if you can see it in the face, they are jaundiced. Maybe not concernedly so, but you'll mainly only know that for sure from the bili level.

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