Guidelines for Managing Neonatal Jaundice

Phototherapy Criteria for Preterm Infants

Gestational Age	Phototherapy (mg/dL)	Exchange Transfusion (mg/dL)
< 28 weeks	5-6	11-14
28-29 weeks	6-8	12-14
30-31 weeks	8-10	13-16
32-33 weeks	10-12	15-18
34-35 weeks	12-14	17-19

Introduction This document outlines comprehensive guidelines for managing jaundice in newborns. These protocols cover diagnosing, monitoring, and treating jaundice, emphasizing both neonatal and adult cases.

Core Topics and Concepts

1. Definition and Causes of Jaundice:

   • Jaundice is characterized by yellowing of the skin and eyes due to elevated bilirubin levels.

   • Common causes include hemolytic conditions, G6PD deficiency, sepsis, and other risk factors.

2. Diagnostic Approach:

   • Laboratory Tests:

     • Complete Blood Count (CBC)

     • Peripheral Blood Smear (PBS)

     • G6PD levels

     • Blood group (ABO/Rh)

     • Direct Antiglobulin Test (DAT)

     • Reticulocyte count

     • For mothers: Blood group (ABO/Rh), Indirect Antiglobulin Test (IAT)

     • Prolonged jaundice: Total Serum Bilirubin (TSB), Direct Bilirubin (DB), Thyroid function test

3. Management Protocols:

   • Phototherapy:

     • Preterm infants (<35 weeks gestational age):

       • <28 weeks: Phototherapy at 5-6 mg/dL, exchange transfusion at 11-14 mg/dL.

       • 28-29 weeks: Phototherapy at 6-8 mg/dL, exchange transfusion at 12-14 mg/dL.

       • 30-31 weeks: Phototherapy at 8-10 mg/dL, exchange transfusion at 13-16 mg/dL.

       • 32-33 weeks: Phototherapy at 10-12 mg/dL, exchange transfusion at 15-18 mg/dL.

       • 34-35 weeks: Phototherapy at 12-14 mg/dL, exchange transfusion at 17-19 mg/dL.

     • Full-term infants (≥35 weeks gestational age):

     • Phototherapy and exchange transfusion criteria are based on risk factors and specific bilirubin levels, with higher thresholds for those without risk factors.

4. Treatment Procedures:

   • Discontinuing Phototherapy:

     • Stop when TSB or MB levels are at least 2 mg/dL below the phototherapy threshold.

   • Urgent Exchange Transfusion:

     • Indications include signs of acute bilirubin encephalopathy, TSB levels at the exchange transfusion threshold, or specific TSB: Albumin ratio thresholds.

5. Monitoring and Follow-up:

   • Post-Phototherapy:

     • Monitor TSB or MB 6-12 hours after stopping phototherapy and the next day if phototherapy was initiated within the first 48 hours of life or if hemolysis is suspected.

   • Post-Discharge Follow-up:

     • Follow-up schedules depend on the difference between the phototherapy threshold and the infant's TSB levels at discharge, with closer monitoring for higher levels.
       

Clinical Relevance and Application

• Practical applications include structured treatment plans for managing neonatal jaundice, and ensuring standardized care to prevent complications like kernicterus.
  

Conclusion The guidelines aim to improve patient outcomes through early detection, appropriate intervention, and consistent follow-up, promoting high-quality care in managing neonatal jaundice.

Specific Numerical Guidelines

1. Phototherapy Criteria for Preterm Infants:

   • <28 weeks: 5-6 mg/dL for phototherapy, 11-14 mg/dL for exchange transfusion.

   • 28-29 weeks: 6-8 mg/dL for phototherapy, 12-14 mg/dL for exchange transfusion.

   • 30-31 weeks: 8-10 mg/dL for phototherapy, 13-16 mg/dL for exchange transfusion.

   • 32-33 weeks: 10-12 mg/dL for phototherapy, 15-18 mg/dL for exchange transfusion.

   • 34-35 weeks: 12-14 mg/dL for phototherapy, 17-19 mg/dL for exchange transfusion.

2. Laboratory Tests for Jaundice Evaluation:

   • CBC, PBS, G6PD levels, Blood group (ABO/Rh), DAT, Reticulocyte count, TSB, DB, Thyroid function test.

3. Post-Phototherapy Monitoring:

   • Follow-up TSB or MB 6-12 hours after stopping phototherapy and the next day if necessary.

4. Post-Discharge Follow-up Criteria:

   • Based on the difference between the phototherapy threshold and the infant's TSB levels at discharge.
     

By adhering to these structured guidelines, healthcare providers can ensure the effective management of neonatal jaundice, reducing the risk of severe complications.