Hyperbilirubinemia/Jaundice/Neonatal Clinical Pathway — Emergency

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Risk Factors

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

*AAP Subcommittee on Hyperbilirubinemia

Neonate with Hyperbilirubinemia/Jaundice

Triage (Critical/Acute)

RN/MD/CRNP Assessment and Bedside Procedure
Heelstick Total Serum Bilirubin (TSB=BU+BC)
Wallaby

History and Physical

Gestational Age Determine Age in Hours

Calculate Total Serum Bilirubin (TSB=BU+BC)
Print Exchange Nomogram
Plot on appropriate curve (according to Risk Factors)
Definition of Pathologic Jaundice

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

YES

Print Phototherapy Nomogram
Plot on appropriate curve
according to Risk Factors

TSB above Phototherapy Threshold

YES

Assure Adequate PO Intake

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, January 2016 (Reviewed), January 2018 (Reviewed)
Authors: D. Aronson, MD, J. Lavelle, MD, C. Jacobstein, MD, N. Boorstein, RN

Learn More

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.