ED Pathway for Evaluation/Treatment of Neonates with Hyperbilirubinemia/Jaundice

Risk Factors

  • Isoimmune Hemolytic Disease
  • G6PD deficiency
  • Asphyxia
  • Significant lethargy
  • Temperature instability
  • Sepsis
  • Acidosis

*AAP Subcommittee on Hyperbilirubinemia

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History and Physical
Gestational Age Determine Age in Hours
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Are ANY of the following present:
  • TSB within 2 mg/dL of exchange threshold
  • Less than 35 weeks gestation
  • Ill appearing
  • Neurologic dysfunction
  • Evidence of hemolysis
  • Pathologic Jaundice
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NO
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YES
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TSB above Phototherapy Threshold
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YES
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NO
Assure Adequate PO Intake
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Discharge to Home
Follow-up with PMD

Admit to General Pediatrics
Add NeoBlue Cozy (Bili Bed)
Encourage PO: Consider NG/OG
Consider IV
Place IV: Obtain Additional Labs
IV fluids if Clinically Dehydrated

Call NICU : 215-490-6797
Add NeoBlue Cozy (Bili Bed)
Place IV: Obtain Additional Labs
IV fluids if Ill-Appearing
Posted : October 2009
Revised : October 2011
Authors : D. Aronson, MD, J. Lavelle, MD, C. Jacobstein, MD, N. Boorstein, RN