![]() Administration of intravenous gamma globulin is an alternative in infants with isoimmune hemolytic disease (dose: 0.5 to 1 g per kg over two hours, may repeat after 12 hours, if necessary).It's worth noting that usage of the cup in modern recipes is mostly confined to the United States and Canada. Only trained personnel in a neonatal intensive care unit should perform exchange transfusion. Symptoms of severe bilirubin encephalopathy include hypertonia, arching, retrocollis, opisthotonos, fever, and high-pitched cry. Worsening bilirubin encephalopathy is characterized by irritability and hypertonia, at times alternating with lethargy. Initial symptoms include poor feeding, hypotonia, and lethargy. Exchange transfusion should be performed immediately in any infant with jaundice and signs of acute bilirubin encephalopathy. The infant should be transferred to a neonatal intensive care unit for immediate intensive phototherapy and consideration of exchange transfusion. Therefore, Baby D has no risk factors and can be seen 48 hours after discharge.Įxchange transfusion is recommended when the TSB level exceeds the threshold in the AAP exchange transfusion nomogram ( Figure 4 2 ), based on age and risk factors, or if the TSB level is greater than 25 mg per dL (428 μmol per L). Baby D, who has the same predischarge bilirubin level as Baby C, is a formula-fed infant delivered at 39 weeks' gestation. Therefore, he has two major risk factors for severe hyperbilirubinemia and should be seen in the primary care office within 24 hours of hospital discharge. For example, Baby C is a breastfed infant delivered at 36 weeks' gestation who has a predischarge bilirubin level in the low-intermediate range. 2 Earlier follow-up (within 24 to 48 hours) should be instituted for infants with more risk factors for severe hyperbilirubinemia, shorter hospital stays, or predischarge bilirubin levels in the high-intermediate or high-risk zones. 2 An infant should be seen by the age of 72 hours if discharged before 24 hours by the age of 96 hours if discharged between 24 and 47.9 hours and by the age of 120 hours if discharged between 48 and 72 hours. Newborns should be examined within 24 to 72 hours of hospital discharge to assess for jaundice and general well-being. If the infant requires phototherapy or if the bilirubin level is increasing rapidly, further work-up is indicated. Another nomogram that consists of age in hours, risk factors, and total bilirubin levels can provide guidance on when to initiate phototherapy. The resultant low-, intermediate-, or high-risk zones, in addition to the infant's risk factors, can guide timing of postdischarge follow-up. Total serum bilirubin or transcutaneous bilirubin levels should be routinely monitored in all newborns, and these measurements must be plotted on a nomogram according to the infant's age in hours. ![]() Secondary prevention is achieved by vigilant monitoring of neonatal jaundice, identifying infants at risk of severe hyperbilirubinemia, and ensuring timely outpatient follow-up within 24 to 72 hours of discharge. Primary prevention includes ensuring adequate feeding, with breastfed infants having eight to 12 feedings per 24 hours. A structured and practical approach to the identification and care of infants with jaundice can facilitate prevention, thus decreasing rates of morbidity and mortality. Kernicterus and neurologic sequelae caused by severe neonatal hyperbilirubinemia are preventable conditions. ![]()
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