Emergency Department Clinical Pathway for Evaluation/Treatment
of Neonates with Hyperbilirubinemia/Jaundice
Related Pathway
- Risk Factors
- Isoimmune Hemolytic Disease
- G6PD deficiency
- Asphyxia
- Significant lethargy
- Temperature instability
- Sepsis
- Acidosis
- AAP Subcommittee on Hyperbilirubinemia
Triage (Critical/Acute)
Use ED Hyperbili/Jaundice in Neonate PathwayNursing Standing Orders
RN/MD/CRNP Assessment and Bedside Procedure
Heelstick Total Serum Bilirubin (TSB=BU+BC)
neoBlue® Blanket
History and Physical
Gestational Age
Determine Age in Hours
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
NO
Assure Adequate PO Intake
Discharge to Home
Follow-up with PMD
Follow-up with PMD
Admit to General Pediatrics
Add neoBlue Light AND neoBlue Blanket
Encourage PO: Consider NG/OG
Consider IV
Place IV: Obtain Additional Labs
IV fluids if Clinically Dehydrated
Contact N/IICU Medical Command
Add neoBlue Light AND neoBlue Blanket
Place IV: Obtain Additional Labs
IV fluids if Ill-Appearing
Add neoBlue Light AND neoBlue Blanket
Place IV: Obtain Additional Labs
IV fluids if Ill-Appearing
Posted: October 2009
Revised: May 2022
Authors: D. Aronson, MD, J. Lavelle, MD, C. Jacobstein, MD, N. Boorstein, RN
Revised: May 2022
Authors: D. Aronson, MD, J. Lavelle, MD, C. Jacobstein, MD, N. Boorstein, RN