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Guidelines for Managing Neonatal Jaundice

Writer: MaytaMayta

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.

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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