hyperbilirubinemia web meeting 2018 dr. ann anderson berry · screening for severe neonatal...
TRANSCRIPT
Hyperbilirubinemia
Web Meeting
2018
Dr. Ann Anderson Berry
Introduction
Objective
• Describe evidence-based practices (EBP) to prevent
hyperbilirubinemia and kernicterus
• All newborns will have a prn bilirubin order (TSB or TCB) to
be initiated at the nurse’s discretion (AAP)
-Visual assessment not accurate (Keren)
AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:
10.1542/peds.114.1.297.
Keren, R., Luan, X., Friedman, S., Saddlemire, S., Cnaan, A., & Bhutani, V. K. (2008). A comparison of alternative risk-assessment strategies
for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics, 121(1), e170-9.
EBP
• Universal predischarge bilirubin screening-TSB or TcB
• Use of clinical risk factors and predischarge bili to predict risk
of hyperbilirubinemia
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in the newborn infant ≥ 35
weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198. DOI:10.1542/peds.2009-0329
Bhutani, V. K., Stark, A. R., Lazzeroni, L. C., Poland, R., Gourley, G. R., Kazmierczak, S., . . . Stevenson, D. K. (2013). Predischarge
screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. The Journal of Pediatrics, 162(3), 477-482.e1.
10.1016/j.jpeds.2012.08.022
EBP
AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.
Pediatrics, 114(1),297-316. DOI: 10.1542/peds.114.1.297.
Risk Factors
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Risk Factors
• Use hour-specific nomogram to interpret bili (Maisels 2009, AAP 2004)
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te newborn infant ≥ 35
weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198. DOI:10.1542/peds.2009-0329
AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:
10.1542/peds.114.1.297.
EBP
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Recommendations for Management and Follow-up
EBP
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Copyright ©2004 American Academy of Pediatrics
Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316
Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation
Maisels, M.J., Bhutani, V.k., Bogen, D., Newman, T.B., Start, A.R., & Watchko, J.F. (2009).Hyperbilirubinemia in te
newborn infant ≥ 35 weeks gestation: An update with clarifications. Pediatrics, 124(4), 1193-1198.
DOI:10.1542/peds.2009-0329
Recommendations for Management and Follow-up
• Written and verbal info to parents at discharge explaining
jaundice and need to monitor for (AAP, 2004)
AAP (2004). Management of Hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1),297-316. DOI:
10.1542/peds.114.1.297.
EBP
SUMMARY
• TSB or TcB if any jaundice noted visually (AAP, Keren) to be initiated by the nurse (NANN 2010)
• Use of clinical risk factors and predischarge bili to predict risk of hyperbilirubinemia (Maisels)
• Universal predischarge bilirubin screening-TSB or TcB (Maisels)
• Use hour-specific nomogram to interpret bili (Maisels 2009, AAP 2004)
• Written and verbal info to parents at discharge explaining jaundice and need to monitor for (AAP 2004)
• Follow up post discharge per algorithm (Maisels 2009)
• G1P0
• 36 5/7 wks gestation
• Hispanic
• PROM
• Apgars 7 & 9
• AB pos
• SVD after 20 hour
labor with oxytocin
• Formula feeding
• Universal bili screen
at 24h with newborn
screen was 10.6
(TSB)
Case 1
Copyright ©2004 American Academy of Pediatrics
Subcommittee on Hyperbilirubinemia, Pediatrics 2004;114:297-316
Guidelines for phototherapy in hospitalized infants of 35 or more weeks' gestation
G4P3
39 weeks
gestation
Caucasian
SVD after 2 hour
labor
O pos
Apgars 9 & 9
Breastfeeding well
Case 2
Post Discharge:
• ER visit 48 hours after discharge (72 hours of life) for poor
feeding – PE Jaundiced
• Bilirubin 24
Questions Can be
Directed to Peggy Brown
or Ann Anderson Berry
through NPQIC.org