From the Guidelines
Jaundice in newborns requires immediate medical attention if it persists or worsens, and parents should be educated on the signs and symptoms to watch for, as well as the importance of frequent feeding and monitoring for severe hyperbilirubinemia, which can be treated with phototherapy, as recommended by the most recent study 1.
Key Points to Educate Parents
- Jaundice typically appears 2-4 days after birth and is characterized by yellowing of the skin and eyes
- Frequent breastfeeding (8-12 times daily) or formula feeding (every 2-3 hours) can help eliminate bilirubin through bowel movements
- Positioning the baby near a window for indirect sunlight can also help, but direct sunlight should be avoided
- Parents should monitor for signs that require immediate medical attention, such as:
- Yellowing that spreads to the abdomen, arms, or legs
- Extreme fussiness
- Difficulty waking or feeding
- High-pitched crying
- Arching of the back
Importance of Phototherapy
- Phototherapy is an essential intervention for severe hyperbilirubinemia, especially in neonates at high risk, as it can reduce the risk of bilirubin neurotoxicity and the need for exchange transfusions 1
- The timing of intervention is guided by serial measurements of total serum/plasma bilirubin (TSB) concentrations and screening for intrinsic risk factors for bilirubin neurotoxicity
- Phototherapy devices should be used according to the manufacturer's instructions, and the baby's surface area should be exposed to the light to maximize the effectiveness of treatment, as described in the study 1
High-Risk Groups
- Premature babies, babies with blood type incompatibilities, or those with feeding difficulties are at higher risk for developing significant jaundice requiring treatment
- These groups should be closely monitored, and phototherapy should be initiated promptly if severe hyperbilirubinemia is diagnosed, as recommended by the most recent study 1
From the Research
Jaundice Newborn Education
- Jaundice is a common condition in newborns, and if left untreated, severe neonatal hyperbilirubinemia may cause kernicterus and ultimately death 2.
- The severity of neonatal jaundice is often underestimated clinically, but timely and correct intensity phototherapy can usually avoid exchange transfusion 2.
- Phototherapy is the use of visible light for the treatment of hyperbilirubinemia in the newborn, and it works by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver 3.
- The dose of phototherapy determines how quickly it works, and it is determined by the wavelength of the light, the intensity of the light, the distance between the light and the infant, and the body surface area exposed to the light 3.
- Intensive phototherapy can decrease the need for exchange transfusion and the duration of phototherapy in neonatal jaundice 4.
- Phenobarbital in combination with phototherapy may be helpful to newborn infants with isoimmune hemolytic disease, as it results in a faster decline in total serum bilirubin, thus decreasing the need for blood exchange transfusion than phototherapy alone 5.
- Proper nursing care enhances the effectiveness of phototherapy and minimizes complications, including ensuring effective irradiance delivery, maximizing skin exposure, providing eye protection and eye care, carefully monitoring thermoregulation, maintaining adequate hydration, promoting elimination, and supporting parent-infant interaction 3.