Adequate nutrition increases enterohepatic circulation and promotes decreased TSB and avoids complications associated with dehydration.
| Feeding Schedule |
- Encourage Frequent Feeding:
- A minimum of at least 8 feeds in 24 hours is recommended
- Infant can be off phototherapy for up to 30 minutes every 2-3 hours to feed
- Use biliblanket during feeds
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| Breastfeeding |
- Protect/Support Breastfeeding Efforts:
- The first week of breastfeeding is critical to milk production
- Initiate breastfeeding within the first hour after birth, assess suckling adequacy
- Initiate pumping with high-quality pump to enhance maternal milk production
- Consult lactation consultant and involve unit-based breastfeeding resource nurse
- Encourage supplementation with expressed milk, donor breast milk or formula as needed if not adequately hydrated and with a joint discussion with the parents.
- Suboptimal Intake Hyperbilirubinemia:
- Formerly known as breastfeeding jaundice
- Attributed to suboptimal intake, peaks at 3-5 days
- Breast Milk Jaundice Syndrome:
- Prolonged elevated unconjugated hyperbilirubinemia that persists with adequate milk intake
- Lasts up to 21 days
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| Intravenous Fluids |
- NG/OG Feeds:
- Always consider NG/OG for enteral feeds as it increases enterohepatic circulation and helps excrete bilirubin
- Consider IVF Fluids if:
- Poor feeding, significant decrease in urine output
- Concerning electrolytes
- TSB level is within 2 points of exchange threshold
- Concern for ongoing hemolysis
- Hemolysis definition: Known DAT+ and retic count > 7%
- IVF Guidance:
- Single IV fluid bolus NS 10 mL/kg
- Check BMP
- Heparin-lock PIV
- Do not start maintenance IVF
- Encourage PO, consider NG/OG (6F) for continued enteral feeds after hydration
- Care Escalation:
- Consult Neonatology if any of the following:
- TSB within 2 mg/dL of exchange threshold
- TSB rate of rise > 0.5 mg/dL/hr
- Evidence of hemolysis
- Add CMP, CBC, reticulocyte count, DAT&S
- NPO, IVFs
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