Jaundice Work-Up and Management After Threshold for Phototherapy

Initial Work-Up

1. Complete Blood Count (CBC) and Peripheral Blood Smear (PBS)

   • CBC: Assess overall health, detect anemia, infection, and other disorders.

   • PBS: Identify abnormal red blood cell shapes, which may indicate hemolytic diseases.

2. Reticulocyte Count

   • Purpose: Measure young red blood cells, which can indicate the bone marrow's response to anemia.

3. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency

   • Purpose: Screen for G6PD deficiency, a common cause of hemolytic jaundice.

4. Blood Group (ABO and Rh) of Both Mother and Child

   • Purpose: Identify ABO or Rh incompatibility which can cause hemolytic disease of the newborn.

5. Direct Antiglobulin Test (DAT) or Coombs Test

   • Purpose: Detect antibodies that are bound to the surface of red blood cells, indicating immune-mediated hemolysis.
     

Follow-Up

1. Hematocrit (HCT)

   • Purpose: Measure the proportion of red blood cells in the blood to assess anemia.

2. Methemalbumin (MB)

   • Purpose: Identify significant hemolysis, as methemalbumin is released during hemolysis.
     

Management After Phototherapy Threshold

1. Phototherapy

   • Indication: Initiate when bilirubin levels reach the threshold according to guidelines based on age in hours and risk factors.

   • Goal: Reduce bilirubin levels through photo-oxidation, making bilirubin more water-soluble and easier to excrete.

2. Hydration

   • Purpose: Maintain adequate hydration to enhance bilirubin excretion.

3. Monitoring Bilirubin Levels

   • Frequency: Regular monitoring of serum bilirubin levels to assess the effectiveness of phototherapy and decide on continuation or escalation of treatment.

4. Exchange Transfusion (if necessary)

   • Indication: Consider if bilirubin levels are dangerously high or if there are signs of acute bilirubin encephalopathy despite intensive phototherapy.

   • Goal: Rapidly decrease serum bilirubin levels and remove antibody-coated red blood cells.
     

Summary

This structured approach ensures a comprehensive evaluation and management plan for jaundiced infants requiring phototherapy. Continuous monitoring and timely interventions based on guidelines are crucial to prevent complications such as kernicterus.