Question concerning neonatal hyperbilirubinemia

Specialties NP

Published

Hi all. I had a neonate the other day (thurs) who was slightly jaundiced and 2 days postpartum. I had a total bilirubin drawn and received a call later on telling me it was 13 (elevated). Unfortunately the delivery labs were not in our system and the person who retrieves them was unable to get them. I talked with more seasoned PAs and NPs at the clinic who all said they look at the trends and make a determination of photo therapy off that. Without the trends, I contacted the mother and told her I would contact in the morning to get an idea of how the baby looked. Mother was somewhat unfazed as a previous child went through the same thing.

The next day (friday), instead of getting new labs drawn, the mother chose to go to the ED. They drew labs and found the TB up to 13.4 and direct bili 0.5. They decided not to treat and suggested to follow up with us the next day (today), but we aren't open on weekends. As I am somewhat concerned, I naturally kept an eye on the chart and that's the only way I knew the outcome of the ED visit. I am wondering if I should be proactive and order the mother a biliblanket now, or hold off until Monday and have her redraw the labs when we are open? On the peds side of the house, this is kind of new territory for me. Just getting some experienced ideas. Thanks!

Edit to add...mom is not breastfeeding.

I remember when I was new and panicking about stuff like this after hours and over the weekend. I know you were just coming here for reassurance and insight. I am however concerned that none of the numerous other providers you asked about this taught you how to use bilitool and how to use those results combined with the clinical presentation to guide your plan. It seems they all see newborns as well and none of them use it either? Or if they do, they didn't advise you to use it also? If you as a new FNP came to me with this question, the first question I would ask you would be "what is the risk level?" Once you told me you didn't know, I would realized that I need to teach you how to use bilitool, I would have you input the data and come back to me with the result so we could discuss what to do. I fear that you are seeing newborns (and patients in general) in an environment where the more seasoned providers aren't interested in teaching you even when you ask. I'm and FNP and see peds as well and agree that it is super important to have a peds provider to go to with questions, eight years out and there are some days when I'm going down the hall to one of my pediatricians 3-4 times a day to ask them to double check a kid for me. Little ones can be tricky! Just be safe, both for the sake of your patients and your license.

Specializes in NICU.

I assume the "bullying" reference was directed to me- correct me if I'm wrong. My post was not bullying and I have a long history of helping allnurses users over the years in a considerate fashion. My post may have been more blunt, but I was honestly quite a bit disconcerted reading the OP's post.

Let me be clear- there is a huge difference between, "please help me understand this disease process or point me to references to help me" versus "please help me manage this particular patient." A provider should not be asking internet strangers on how to manage a particular patient. For one thing, we don't have the full medical picture which can dramatically change the advice given. I don't think it's impossible a certain amount of liability could exist on the poster giving medical advice. For another you can't verify our credentials and therefore ethically shouldn't take the advice on how to manage a particular patient based on what a poster said to do who claimed to be a NP.

If it felt harsh when I said this was basic newborn care 101, then I'm sorry if your feelings were hurt, but it is no less true. If you were not given an appropriate orientation on the care of newborns, then you should ask your practice to provide you with one. I do wish you well in your clinical practice.

Specializes in NICU.

Full term,average weight?At this point he is 3 days old but how many hours,did you use bili tool?That would have told you hi or low risk based on hours of age etc and whether therapy is needed.How was the skin assessment?How is baby feeding? well or poor feeder?activity level?active or lethargic?Hydrated or dehydrated,voiding enough?What is your policy and protocol?

Specializes in NICU.

Yup and those that fall through the cracks,get hurt really bad.

a case study is nurses eating their own, even at this level. smh

Yep. This thread reminds me of many of my own experiences when I first began working in CVICU a long time ago.

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