Hyperbilirubinemia is one the most common reasons for emergency department visits for the neonate. This month’s issue, Neonatal Hyperbilirubinemia: Recommendations for Diagnosis and Management in the Emergency Department, reviews the emergency department evaluation and management of neonatal hyperbilirubinemia and discusses how to recognize acute bilirubin encephalopathy, with the goal of preventing kernicterus.
Recommendations are provided for risk stratification and determining the need for phototherapy or exchange transfusion, using nomograms to plot total serum bilirubin levels and taking into consideration hyperbilirubinemia and neurotoxicity risk factors.
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Here are a few key points:
- Using age in hours and a TSB level, the AAP recommends using the hour-specific nomogram to determine appropriate management and follow-up to reduce the risk of severe hyperbilirubinemia.
- The presence of hyperbilirubinemia risk factors is used to help interpret the results of the hour-specific nomogram. Hyperbilirubinemia risk factors include:
- A newborn nursery predischarge TSB in the high-risk zone
- Jaundice observed in the first 24 hours
- ABO incompatibility or other known hemolytic disease
- Gestational age 35 to 36 weeks