Jaundice Basics
What builds up in a newborn's body and makes their skin look yellow?
Unconjugated bilirubin accumulates in the skin and tissues (bilirubin is produced by breakdown of red blood cells)
How can a baby not getting enough milk increase their risk for jaundice?
Suboptimal intake / poor milk transfer (inadequate intake can reduce stooling and bilirubin elimination)
What does "TSB" in a newborn's chart stand for?
Total Serum Bilirubin (TSB is the definitive test used for phototherapy and escalation decisions)
What treatment uses special blue light to help lower a baby's bilirubin?
Phototherapy (light converts bilirubin to forms that can be eliminated without conjugation)
Yellowing of skin and/or sclera
If a newborn has normal physiologic jaundice, when would you usually first notice it?
After their first 24 hours of life (Jaundice in the first 24 hours needs prompt bilirubin measurement and evaluation)
Why would a baby with a lot of bruising after delivery be at a higher risk for jaundice?
Cephalohematoma or extensive bruising (breakdown of extravasated blood increases bilirubin load)
What test can we used to check a baby's bilirubin without drawing blood?
Transcutaneous Bilirubin (TcB)
What are THREE things you should continue to check while a baby is under phototherapy lights?
1. Temperature
2. Hydration/feeding
3. Output
What could you do as the nurse to help a jaundiced newborn who isn't feeding well?
Assess their latch/milk transfer and support frequent effective feeding
What organ is still immature in newborns and has trouble processing bilirubin?
The Liver (immature hepatic conjugation contributes to newborn jaundice)
ABO Incompatibility and Rh Incompatibility (hemolysis can cause rapid bilirubin rise)
When checking bilirubin, why does it matter if a baby is 12 hours old versus 48 hours old?
Why do we leave most of the baby's skin uncovered during phototherapy?
It increases the skin surface exposed to therapeutic light
What are two symptoms would make you worry that high bilirubin is affecting the baby's brain?
Lethargy, poor feeding, high-pitched cry, abnormal tone or arching (these signs warrant an immediate escalation)
What are two reasons newborns are more likely to get jaundice than adults?
1. Higher red cell turnover
2. Immature hepatic conjugation
Why do babies born before 38 weeks have a higher risk of jaundice?
Less mature bilirubin handling and increased vulnerability to neurotoxicity (gestational age affects treatment thresholds)
Besides age in hours, what are two things we need to know that help decide if a baby needs treatment?
Gestational age and Neurotoxicity risk factors
Why do we cover a newborn's eyes during overhead phototherapy?
Properly fitted protective eye covering per equipment protocol
When a parent says, "I'll put my baby in direct sunlight to treat jaundice", how do you respond?
Explain that sunlight is not a safe or reliable substitute for prescribed care of jaundice
What serious brain complication can happen if bilirubin gets dangerously high?
Kernicterus (chronic bilirubin encephalopathy) (early recognition and treatment help prevent permanent neurologic injury)
Scenario: You notice a 10 hour hold newborn starts to look yellow. What should you do first?
Notify the provider for evaluation and obtain a prompt bilirubin measurement (visible jaundice in the first 24 hours is NOT assumed physiologic)
A baby's skin bilirubin reading is close to the phototherapy cutoff. What test should we get next?
A confirmatory TSB
If bilirubin becomes dangerously high, what emergency treatment might the baby need?
Exchange transfusion (with urgent escalation of care that is guided by TSB, age, risk factors, and other clinical findings)
What are three things you would teach parents before taking a baby home with jaundice?
Feeding adequacy, warning signs, and specific bilirubin follow up plans (follow up timing depends on bilirubin relative to treatment threshold and other factors)