Page 18 - 16Neonatal Jaundice_compressed

Neonatal jaundice

ID Recommendations See Chapter/Section
49 Follow expert advice about care for babies with a conjugated bilirubin 6.2
level greater than 25 micromol/litre because this may indicate serious liver
disease.
Intravenous immunoglobulin

50 Use intravenous immunoglobulin (IVIG) (500 mg/kg over 4 hours) as an 7.4
adjunct to continuous multiple phototherapy in cases of Rhesus
haemolytic disease or ABO haemolytic disease when the serum bilirubin
continues to rise by more than 8.5 micromol/litre per hour.
51 Offer parents or carers information on IVIG including: 8
• why IVIG is being considered
• why IVIG may be needed to treat significant hyperbilirubinaemia
• the possible adverse effects of IVIG
• when it will be possible for parents or carers to see and hold the baby.
52 8
Exchange transfusion
Offer parents or carers information on exchange transfusion including:
• the fact that exchange transfusion requires that the baby be admitted to
an intensive care bed
• why an exchange transfusion is being considered
• why an exchange transfusion may be needed to treat significant
hyperbilirubinaemia
• the possible adverse effects of exchange transfusions
• when it will be possible for parents or carers to see and hold the baby
after the exchange transfusion.
53 Use a double-volume exchange transfusion to treat babies: 7.3
• whose serum bilirubin level indicates its necessity (see threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6))
and/or
• with clinical features and signs of acute bilirubin encephalopathy.
54 During exchange transfusion do not : 7.3
• stop continuous multiple phototherapy
• perform a single-volume exchange
• use albumin priming
• routinely administer intravenous calcium.
55 Following exchange transfusion: 7.3
• maintain continuous multiple phototherapy
• measure serum bilirubin level within 2 hours and manage according to
threshold table (Section 1.3) and treatment threshold graphs
(Section 1.6).

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