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

History and Physical

Review discharge sheet, if available

Birth History

  • Gestational age
  • Date, time of birth
  • Birthweight
  • Delivery details (forceps, vacuum, etc.)
  • Maternal blood type
    • If mom is O, call birth hospital for antibody screen

HPI

  • Feeding: breast/formula, duration & frequency of feed, intake in past 24 hours
  • Urine output in past 24 hours
  • Pattern of stooling
  • Presence of fever, method of temperature measurement,
    Tylenol use
  • Signs of bilirubin encephalopathy:
Early: Lethargy, hypotonia, high-pitched cry, poor feeding
Intermediate: Irritability, retrocollis, opisthotonos, fever
Advanced Apnea, stupor, coma

Pertinent Family History

  • Sibling received phototherapy
  • Hematologic disorders (eg: G6PD-deficiency, hereditary spherocytosis, known blood group incompatibility)

Physical Assessment

  • Vital signs, weight
  • General appearance
  • Hydration status
  • Abdominal exam: hepatomegaly, splenomegaly
  • Neurologic exam: tone, retrocollis, opisthotonus
  • Skin exam: bruising, petechiae, pallor, scalp hematoma
  • Assess for jaundice:
    • Cephalocaudal progression
    • Scleral icterus
    • Apply gentle pressure with 1 finger to reveal color of skin and subcutaneous tissue