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Laraeeb Abbasi

ISM-Period 6

. Cabra, Monica A., and Jonathan M. Whitfield. "The challenge of preventing

neonatal bilirubin encephalopathy: a new nursing protocol in the well

newborn nursery." Baylor University Medical Center Proceedings, vol. 18, no.

3, 2005, p. 217+. Academic OneFile,



Accessed 30 Mar. 2017

Jaundice is quite common in otherwise healthy newborn infants

Jaundice is caused by a normal adaptive physiological processes and generally peaks in
severity between 3-5 days post- birth, and is normally cured in the next 7-10 days.
When bilirubin levels rise to toxic levels, bilirubin encephalopathy and subsequent kernicterus
can occur.
Bilirubin is a yellow compound that breaks down heme in vertebrates
Neonatal jaundice is normally treated by Phototherapy
There has recently been a relative increase in the number of infants being diagnosed with
jaundice throughout the nation
Clinical estimation of jaundice severity is notoriously inaccurate. This is often due to the early
discharge of newborns especially if it is before bilirubin levels have had time to peak, this results
in the hospital-based risk assessment an essential step before discharge of the infant to ensure
they do not develop jaundice later.
In 1994, the American Academy of Pediatrics (AMA) published a guideline to provide a method
to prevent and manage hyperbilirubinemia. However, this guideline did little to reduce
neurological damage as a result of hyperbilirubinemia
In 2004, the AAP published a new guideline to manage hyperbilirubinemia in newborn infants of
35 weeks gestational age or more
Guidelines in the 2004 version of the AAPs report include the requirements of establishing
nursery protocols for identifying and evaluating hyperbilirubinemia, stop relying on sole visual
identification of the degree of jaundice affecting the infant as it can result in the erroneous
identification especially in infants with darker skin, to interpret all bilirubin levels according to
the infants hourly age, recognize that infants at less than 38 weeks gestation especially those that
are breastfed are at a higher risk of developing hyperbilirubinemia and should be monitored, the
need to perform systematic assessments on all infants prior to discharge
Early detection of infants at risk of severe hyperbilirubinemia is an important step in preventing
bilirubin encephalopathy and kernicterus
Trend for fewer hospital readmissions for hyperbilirubinemia has been noted as a result of these
new guidelines
This source deeply analyzed and dissected the changes in jaundice and hyperbilirubinemia in the past
decade. I never realized how common yet easily preventable these two issues are. It really opened my
eyes to how positively even the most small seeming changes, such as implementing a set of guidelines
can impact national averages of an illness in such a major way