Jaundice Diagnosis Care Plan: Comprehensive Guide for Neonatal Hyperbilirubinemia

Hyperbilirubinemia, commonly known as jaundice, is a prevalent condition in newborns, characterized by elevated serum bilirubin levels. This elevation stems from the breakdown of red blood cells (hemolysis) and the subsequent reabsorption of unconjugated bilirubin from the intestines. While often benign, neonatal jaundice can pose significant risks, potentially leading to severe complications if not properly diagnosed and managed.

The immaturity of a newborn’s liver plays a crucial role in the development of jaundice. The liver’s primary function is to clear bile pigments, a byproduct of the natural postnatal destruction of red blood cells, from the blood. In newborns, this process is not yet fully efficient, leading to a buildup of bilirubin. Higher bilirubin levels correlate directly with the depth of jaundice and the risk of neurological damage. It’s essential to differentiate between physiological jaundice, a normal transient condition, and pathological jaundice, which is more serious and arises within the first 24 hours of life, often due to underlying conditions like ABO or Rh incompatibility. Premature infants are particularly susceptible to hyperbilirubinemia due to a slower bilirubin level rise and prolonged duration of jaundice.

Physiological jaundice is the most frequently observed form of newborn hyperbilirubinemia. This unconjugated hyperbilirubinemia typically manifests after the first 24 hours of life and can persist for up to a week. Pathological jaundice, in contrast, is defined by its early onset (within 24 hours), a rapid increase in serum bilirubin exceeding 5 mg/dl/day, conjugated bilirubin levels at or above 20% of total serum bilirubin, abnormally high peak bilirubin levels, and clinical jaundice lasting beyond two weeks. Breast milk jaundice presents a unique scenario, occurring in breastfed newborns between days one and three, peaking around days 5 to 15, and gradually declining by the third week of life.

Historically, Rh blood type incompatibility was the leading cause of hemolytic disease in newborns. However, with the advent of Rh antibody prevention nearly 50 years ago, ABO incompatibility has become the more common culprit. In both cases, the underlying mechanism involves the mother developing antibodies against the fetal red blood cells due to differing blood types. This leads to hemolysis, resulting in severe anemia and hyperbilirubinemia in the newborn.

Nursing Care Plans and Management for Neonatal Jaundice

Effective nursing care for hyperbilirubinemia is crucial to prevent the condition’s progression and potential complications. The primary goals of a Jaundice Diagnosis Care Plan are to:

Prevent injury and mitigate the progression of hyperbilirubinemia.
Provide comprehensive support and education to the family.
Maintain physiological homeostasis, ensuring bilirubin levels decrease.
Prevent potential complications associated with hyperbilirubinemia.

Nursing Problem Priorities in Jaundice Management

The following nursing priorities are paramount in managing patients with hyperbilirubinemia:

Bilirubin Level Monitoring: Regular and meticulous monitoring of bilirubin levels is essential to ascertain the severity of hyperbilirubinemia and guide treatment strategies.
Identification of Underlying Cause: A thorough investigation to identify the root cause of hyperbilirubinemia is crucial for targeted and effective treatment.
Phototherapy Administration and Management: Initiating and expertly managing phototherapy is a cornerstone of treatment, facilitating bilirubin breakdown and reducing blood levels.
Blood Transfusion Considerations: In severe cases of hyperbilirubinemia, particularly those unresponsive to phototherapy, blood transfusion to remove excess bilirubin and replenish red blood cells may be necessary.
Comprehensive Neonatal Assessment: A detailed neonatal assessment is vital to evaluate the infant’s overall health status and identify any concurrent issues related to hyperbilirubinemia.
Parent Education and Support: Educating parents about jaundice causes, management, warning signs, and the importance of follow-up care is critical for home management and early intervention.
Liver Function Evaluation: Assessing liver function helps determine if underlying liver disorders contribute to hyperbilirubinemia, influencing the care plan.
Collaboration with Pediatric Specialists: Effective communication and collaboration with pediatricians and specialists ensure holistic and coordinated care for the infant.
Breastfeeding Support and Guidance: Providing tailored support to breastfeeding mothers optimizes feeding practices, which can aid in bilirubin elimination and overall infant health.
Long-Term Follow-Up Planning: Establishing a plan for long-term follow-up is crucial to monitor jaundice resolution and detect any potential long-term effects or complications early on.

Nursing Assessment for Neonatal Jaundice

A comprehensive nursing assessment is essential for developing an effective jaundice diagnosis care plan. This includes gathering both subjective and objective data.

Subjective Data:

Maternal history: Review prenatal and intrapartum records for risk factors such as Rh or ABO incompatibility, prematurity, infections, and maternal illnesses.
Feeding history: Assess feeding method (breast or formula), frequency, and adequacy of intake. Note any difficulties with feeding.
Family history: Inquire about family history of jaundice, liver diseases, or hemolytic anemias.
Parental concerns: Address parental anxieties and understanding of jaundice, its causes, and treatment.

Objective Data:

Physical Examination:
- Skin and sclera: Observe for jaundice progression, starting from the face and moving downwards. Assess skin color in natural daylight. Blanch skin to reveal underlying yellow discoloration.
- Vital signs: Monitor temperature, heart rate, and respiratory rate. Hypothermia or instability can exacerbate jaundice.
- Weight: Monitor daily weight to assess hydration status, especially during phototherapy.
- Hydration status: Assess fontanels, mucous membranes, skin turgor, and urine output for signs of dehydration.
- Neurological status: Observe for lethargy, irritability, abnormal reflexes, poor feeding, high-pitched cry, or seizures, which may indicate bilirubin encephalopathy (kernicterus).
- Abdomen: Palpate for hepatosplenomegaly, which can suggest hemolytic disease or liver dysfunction.
- Urine and stool: Note color and frequency. Dark urine and pale stools can indicate conjugated hyperbilirubinemia.
Laboratory Data:
- Total and direct bilirubin levels: Monitor serum bilirubin levels to determine the severity of hyperbilirubinemia and guide treatment.
- Blood type and Rh factor: Determine infant and maternal blood types and Rh factors to assess for ABO or Rh incompatibility.
- Coombs test (direct and indirect): Evaluate for hemolytic disease.
- Complete blood count (CBC) with peripheral smear: Assess for anemia, reticulocytosis, and abnormal red blood cell morphology, suggesting hemolysis.
- Serum albumin: Low albumin levels can increase the risk of bilirubin neurotoxicity.
- Glucose: Monitor for hypoglycemia, which can exacerbate jaundice.
- Liver function tests (LFTs): In cases of suspected pathological jaundice or prolonged jaundice, LFTs may be necessary to evaluate liver function.

Nursing Diagnosis for Neonatal Jaundice

Based on the nursing assessment, appropriate nursing diagnoses for neonatal jaundice may include:

Risk for Injury related to hyperbilirubinemia and potential for bilirubin-induced neurological dysfunction (kernicterus).
Deficient Knowledge of jaundice etiology, treatment, and home care management, related to information deficit or misinterpretations.
Interrupted Breastfeeding related to medical recommendations for temporary cessation of breastfeeding to manage hyperbilirubinemia.
Risk for Deficient Fluid Volume related to increased insensible water loss during phototherapy and inadequate fluid intake.
Impaired Skin Integrity related to phototherapy treatment and frequent stools.
Anxiety of parents related to infant’s condition, treatment procedures, and potential complications.
Ineffective Thermoregulation related to phototherapy treatment and environmental exposure.

Nursing Goals for Neonatal Jaundice

The goals and expected outcomes for a jaundice diagnosis care plan are centered around reducing bilirubin levels, preventing complications, and supporting the family:

Parental Understanding: The parents will verbalize understanding of the causes, treatment, and potential outcomes of hyperbilirubinemia.
Symptom Recognition: The parents will be able to identify signs and symptoms in the infant that require prompt medical attention.
Competent Home Care: The parents will demonstrate appropriate care techniques for managing jaundice at home, if applicable.
Bilirubin Level Reduction: The neonate will exhibit decreasing serum bilirubin levels within the therapeutic range. For example, indirect bilirubin levels below 12 mg/dL in term infants at three days of age.
Jaundice Resolution: The neonate will show visible resolution of jaundice, typically by the end of the first week of life.
Neurological Integrity: The neonate will remain free from central nervous system (CNS) involvement or neurological sequelae related to hyperbilirubinemia.
Complication-Free Exchange Transfusion: If required, the neonate will complete the exchange transfusion procedure without complications.
Stable Vital Signs: The neonate will maintain stable body temperature and fluid balance within normal physiological limits.
Intact Skin Integrity: The neonate will be free of skin or tissue injury related to jaundice treatment.
Normal Interaction Patterns: The neonate will demonstrate expected interaction patterns, indicating neurological well-being.

Nursing Interventions and Actions for Neonatal Jaundice

Therapeutic nursing interventions and actions for patients with hyperbilirubinemia are multifaceted and aim to address the priorities outlined earlier.

1. Patient Education and Health Teachings

Effective patient education is paramount, especially as newborns are often discharged home during the peak bilirubin levels.

Assess Family Situation and Support Systems: Evaluate the family’s support network and resources to tailor education and home care plans effectively. New parents often require significant support, especially when facing unexpected health issues in their newborn.
Evaluate Knowledge and Understanding: Determine the parents’ current understanding of jaundice to address specific knowledge gaps and clarify misinformation.
Provide Written Home Phototherapy Instructions: Offer clear, written instructions on home phototherapy techniques, potential problems, and crucial safety precautions. This is vital for ensuring adherence and preventing complications. Kaplan et al. (2019) highlight the importance of detailed written instructions in improving follow-up rates for jaundice management.
Discuss Home Therapy Monitoring: Explain how to monitor home therapy effectively, including recording infant weight, feedings, intake/output, stools, temperature, and recognizing and reporting changes in infant status. Home phototherapy is generally suitable for full-term infants over 48 hours old with bilirubin levels between 14 and 18 mg/dL and no direct bilirubin elevation (Morrison, 2021).
Explain Jaundice Types, Pathophysiology, and Implications: Provide comprehensive information about different types of jaundice (physiological, pathological, breast milk jaundice), their causes, and potential long-term implications of hyperbilirubinemia. Encourage questions and provide clear, concise answers to reduce parental anxiety and promote informed decision-making.
Discuss Home Management of Mild Jaundice: Educate parents on managing mild physiological jaundice at home, including strategies like increasing feeding frequency, providing indirect sunlight exposure (with careful monitoring), and adhering to a follow-up serum bilirubin testing schedule. Emphasize indirect sunlight and caution against direct sun exposure due to the risk of thermal injury to the infant’s delicate skin.
Breastfeeding and Milk Supply Information: Provide guidance on maintaining milk supply using a breast pump if breastfeeding needs temporary interruption. Offer support for re-establishing breastfeeding once jaundice is managed. For preterm infants, demonstrate how to manually express breast milk and bottle-feed if necessary.
Demonstrate Bilirubin Level Assessment: Teach parents how to assess their infant for worsening jaundice by blanching the skin, monitoring weight, and observing for behavioral changes. Early detection is crucial for timely intervention.
Provide 24/7 Emergency Contact Information: Give parents a 24-hour emergency telephone number and contact person, emphasizing the importance of promptly reporting increased jaundice or any concerning signs. Sardari et al. (2019) underscore the importance of parental awareness and early referral in reducing jaundice complications.
Review Hospital Procedures and Therapies: Explain the rationale behind hospital procedures like phototherapy and exchange transfusions, especially if the infant remains hospitalized after the mother’s discharge. Keeping parents informed reduces anxiety and facilitates informed consent.
Discuss Long-Term Effects of Hyperbilirubinemia: Educate parents about potential long-term effects of severe hyperbilirubinemia, such as kernicterus and associated neurological sequelae including cerebral palsy, developmental delays, and hearing impairment.
Rh Immunoglobulin (RhIg) Education: For Rh-negative mothers with Rh-positive infants, explain the need for RhIg administration within 72 hours postpartum to prevent Rh sensitization in future pregnancies.
Follow-up Bilirubin Testing Arrangements: Ensure arrangements for follow-up serum bilirubin testing at the same laboratory facility to monitor bilirubin levels effectively and detect rebound hyperbilirubinemia after treatment cessation.
Home Phototherapy Program Referral and Education: If home phototherapy is appropriate, provide referral information and comprehensive education on using home phototherapy equipment, safety measures, and monitoring parameters. Educate parents on using phototherapy blankets or fiberoptic pads, ensuring eye protection, and proper infant positioning under lights.

2. Promoting Safety and Preventing Injuries and Complications

Safety is paramount in managing neonatal jaundice to prevent bilirubin-induced neurotoxicity and other complications.

Assess Infant/Maternal Blood Groups and Types: Determine infant and maternal blood types and Rh factors to identify risks for ABO and Rh incompatibility, which increase jaundice risk. ABO incompatibility is common in mothers with type O blood.
Assess Infant in Daylight: Evaluate jaundice in natural daylight to avoid misinterpretation of skin color under artificial lighting. Jaundice often becomes clinically apparent within the first 24 hours in cases of Rh and ABO incompatibility.
Review Birth Condition and Risk Factors: Review birth records for resuscitation needs, bruising, petechiae, cold stress, asphyxia, or acidosis, as these conditions can exacerbate hyperbilirubinemia. Asphyxia and acidosis can reduce bilirubin-albumin binding affinity.
Identify Intrapartal Risk Factors: Note risk factors like low birth weight, prematurity, IUGR, metabolic disorders, vascular injuries, sepsis, or polycythemia, which increase the risk of CNS involvement due to a compromised blood-brain barrier.
Observe Sclera, Mucosa, and Skin for Jaundice: Assess jaundice progression from face to extremities, noting sclera and oral mucosa. Clinical jaundice is typically visible at bilirubin levels above 7-8 mg/dL in term infants. Be aware that yellow undertones can be normal in dark-skinned infants.

Alt text: A nurse gently presses on a newborn baby’s forehead to assess jaundice. The skin under her finger is yellow, indicating the presence of jaundice.

Evaluate Nutritional Levels and Hypoproteinemia: Assess maternal and prenatal nutrition, noting potential neonatal hypoproteinemia, especially in preterm infants. Hypoproteinemia reduces bilirubin-binding capacity, increasing unbound bilirubin levels. Albumin is crucial for bilirubin transport and detoxification (Gounden et al., 2021).
Note Jaundice Onset and Type: Determine the age of jaundice onset and differentiate between physiological, breast milk, and pathological jaundice. Pathological jaundice appearing within 24 hours carries a higher risk of kernicterus.
Assess for Signs and Behavioral Changes: Monitor for signs of kernicterus, including lethargy, poor feeding, irritability, high-pitched cry, arching of the back (opisthotonos), and seizures. Kernicterus-related behavioral changes usually appear between the 3rd and 10th day of life (Amin et al., 2018).
Evaluate for Pallor, Edema, Hepatomegaly, Splenomegaly: Assess for signs of hydrops fetalis, Rh incompatibility, and in utero hemolysis, such as pallor, edema, and enlarged liver and spleen.
Regular Bilirubin Level Monitoring: Frequently assess bilirubin levels to evaluate hyperbilirubinemia severity and phototherapy effectiveness. Significant jaundice is defined as bilirubin levels exceeding 14 mg/dL in preterm infants and 17 mg/dL in term infants (Hansen & Aslam, 2017).
Assess for Hypoglycemia: Monitor for hypoglycemia, as it can exacerbate jaundice. Hypoglycemia leads to fat breakdown, releasing fatty acids that compete with bilirubin for albumin-binding sites.
Initiate Early Feedings: Initiate early oral feedings within 4-6 hours after birth, especially breastfeeding. Early feeding promotes intestinal flora establishment, reduces bilirubin enterohepatic circulation, and facilitates meconium passage (Aynalem et al., 2020).
Maintain Thermoregulation: Keep the infant warm and dry, monitoring skin and core temperature. Cold stress increases fatty acid release, competing with bilirubin binding and increasing unbound bilirubin.
Transcutaneous Jaundice Meter Application: Utilize a transcutaneous jaundice meter for bilirubin screening in newborns ≥35 weeks gestation. TcB measurements are a non-invasive way to estimate bilirubin levels (Maya-Enero et al., 2021).
Consider Breastfeeding Interruption: In some cases, temporarily discontinue breastfeeding for 24-48 hours to reduce bilirubin levels. Formula feeding can increase GI motility and bilirubin excretion. Beta-glucuronidase in breast milk may contribute to bilirubin reabsorption (Hansen & Aslam, 2017).
Monitor Laboratory Studies: Regularly monitor laboratory values, including direct and indirect bilirubin, Coombs test results, CBC, serum protein, and glucose. See Diagnostic and Laboratory Procedures section for details.
Calculate Bilirubin-Albumin Binding Capacity: Calculate the bilirubin-albumin binding capacity to assess kernicterus risk and guide treatment decisions.
Initiate Phototherapy: Implement phototherapy per protocol, using fluorescent bulbs or a bile blanket. Phototherapy photoisomerizes bilirubin in subcutaneous tissue, making it water-soluble for excretion in stool and urine.

Alt text: A newborn infant lies comfortably under blue phototherapy lights, wearing eye protection and a diaper, to treat jaundice.

Administer Enzyme Induction Agents: In specific cases, administer enzyme induction agents like phenobarbital to enhance bilirubin metabolism. Phenobarbital can reduce serum bilirubin levels (Hansen & Aslam, 2017).
Prepare for Exchange Transfusion: Assist with preparation and administration of exchange transfusion if indicated for severe hyperbilirubinemia or blood incompatibility. Exchange transfusion removes sensitized red cells and reduces bilirubin levels.
Cord Condition Assessment: Assess the infant’s umbilical cord condition before exchange transfusion if the umbilical vein is used. Saline soaks may be needed to soften the cord.
Verify Blood Compatibility: Double-check infant and maternal blood types and Rh factors, and ensure compatibility of transfusion blood (typically O Rh-negative).
Pre- and Post-Transfusion Weight Assessment: Weigh the infant before and after transfusion to monitor for fluid overload and weight changes.
Neurological Status Monitoring: Continuously monitor for neurological changes, such as irritability, twitching, seizures, or lethargy, indicating bilirubin neurotoxicity.
Bleeding Assessment Post-Transfusion: Assess for bleeding at the IV site after transfusion due to heparinized or citrated blood altering coagulation. Thrombocytopenia is a potential complication (Chacham et al., 2019).
Monitor Vital Signs During Transfusion: Closely monitor venous pressure, pulse, color, and respiratory rate before, during, and after exchange transfusion to detect adverse reactions like apnea or cardiac dysrhythmias.
Electrolyte Imbalance Monitoring: Monitor for electrolyte imbalances, especially hypocalcemia and hyperkalemia, during and after transfusion, manifested by lethargy, seizures, or bradycardia. Citrate in donor blood can cause hypocalcemia (Chacham et al., 2019).
Assess for Congenital Diseases: Evaluate for congenital hemolytic diseases or cardiac failure, which may necessitate immediate exchange transfusion.
Maintain Infant Temperature During Procedures: Maintain the infant’s temperature using a radiant warmer during procedures like exchange transfusion to prevent hypothermia and vasospasm.
Warm Blood Before Infusion: Warm donor blood using a commercial blood warmer to prevent hypothermia and avoid red cell damage. Do not overheat.
Ensure Freshness of Blood: Use fresh blood (less than two days old), preferably heparinized blood, for exchange transfusions to minimize hemolysis and cytokine-related risks (Ahmed & Ibrahim, 2018).
Resuscitative Equipment Availability: Ensure resuscitative equipment is readily available during exchange transfusion due to potential life-threatening complications.
NPO Status Before Transfusion: Maintain NPO status for 4 hours before exchange transfusion or aspirate gastric contents to prevent aspiration.
Document Transfusion Events: Meticulously document all events during transfusion, including blood volumes withdrawn and injected, to prevent fluid imbalance errors.
Albumin Administration Consideration: Consider administering albumin before transfusion to increase bilirubin-binding capacity, although its effectiveness is debated (Vodret et al., 2015).
Antibiotic Administration: Administer antibiotics as indicated to prevent or treat infections, especially post-transfusion at the umbilical site.
IVIG Administration Assistance: Assist with intravenous immunoglobulin (IVIG) administration in hemolytic disease to reduce the need for exchange transfusion (Wagle & Aslam, 2017).
Monitor for Biliary/Intestinal Obstruction: Observe for signs of biliary or intestinal obstruction, as phototherapy is contraindicated in these conditions. Phototherapy may increase the risk of intestinal obstruction in premature infants (Wang et al., 2021).
Monitor Skin and Core Temperature Regularly During Phototherapy: Monitor temperature every two hours and regulate incubator temperature to maintain thermoregulation during phototherapy.
Note Stool and Urine Color and Frequency: Monitor stool and urine color and frequency. Greenish, loose stools and urine indicate bilirubin excretion effectiveness. Differentiate phototherapy-induced stools from true diarrhea.
Monitor Fluid Intake and Output: Accurately monitor fluid intake and output and weigh the infant twice daily to detect dehydration, especially during phototherapy. Watch for signs of dehydration like reduced urine output, sunken fontanels, and poor skin turgor.
Evaluate Skin and Urine Appearance: Assess skin and urine for brownish-black color, indicative of bronze baby syndrome, a rare phototherapy side effect.
Note Behavioral Changes: Monitor for behavioral changes like lethargy or irritability, which may indicate kernicterus or hypocalcemia post-phototherapy (Wang et al., 2021).
Assess for Rash and Petechiae: Assess for rash and petechiae, potential phototherapy side effects. Petechiae may indicate light-induced thrombocytopenia.
Note Fussiness and Crying: Document increased fussiness or crying episodes during phototherapy, potentially related to circadian rhythm changes.
Document Phototherapy Lamp Details: Document the type of lamp, hours since bulb replacement, and distance from the infant to ensure optimal phototherapy delivery.
Measure Photon Energy: Use a photometer to measure photon energy output of fluorescent bulbs to ensure adequate light intensity for therapy.
Cover Male Infant’s Testes and Penis: Protect male infants’ testes and penis during phototherapy due to potential reproductive effects of light exposure (Cetinkursun et al., 2006).
Apply and Monitor Eye Patches: Apply eye patches, inspect eyes every two hours, and frequently monitor patch placement to prevent retinal damage from phototherapy (Wang et al., 2021).
Cleanse Infant’s Eyes: Cleanse eyes with sterile or normal saline water to prevent conjunctivitis associated with prolonged eye patch use.
Reposition Infant Regularly: Reposition the infant every two hours to ensure even skin exposure to phototherapy and prevent pressure sores.
Perianal Care: Provide meticulous perianal care after each stool to prevent skin irritation from frequent, loose stools.
Encourage Increased Oral Fluid Intake: Increase oral fluid intake to compensate for insensible water loss during phototherapy and prevent dehydration.
Parent-Infant Interaction: Bring infant to parents for feedings, encourage bonding activities, and promote parent interaction to foster attachment and minimize separation anxiety.
Chest Shielding During Phototherapy: Ensure proper chest shielding during phototherapy to potentially reduce the risk of patent ductus arteriosus, especially in premature infants (Wang et al., 2021).

3. Pharmacologic Support

Pharmacological interventions play a supportive role in managing neonatal jaundice.

Sodium Bicarbonate Administration: Administer sodium bicarbonate to correct acidosis, as appropriate. Higher serum pH may enhance bilirubin-albumin binding.
Fluid Administration: Administer enteral or parenteral fluids to compensate for fluid losses, maintain hydration, and provide nutrition if oral feedings are temporarily withheld. Increase maintenance fluid by 10 ml/kg/day in premature infants under conventional phototherapy (Sawyer & Nimavat, 2018).

4. Monitoring Diagnostic and Laboratory Procedures

Continuous monitoring of diagnostic and laboratory results is crucial to evaluate treatment efficacy and patient status.

Direct and Indirect Bilirubin Monitoring: Regularly monitor direct and indirect bilirubin levels. Elevated indirect bilirubin levels are a primary indicator of kernicterus risk. Significant levels are >18-20 mg/dl in term infants and >13-15 mg/dl in preterm infants (Hansen & Aslam, 2017).
Total Serum Bilirubin Level Monitoring: Track total serum bilirubin levels to assess jaundice severity and treatment response.
Coombs’ Test Interpretation: Evaluate direct and indirect Coombs’ test results on cord blood to detect antibodies and confirm hemolytic disease.
CO2-combining Power, Reticulocyte Count, and Peripheral Smear Analysis: Monitor CO2-combining power, reticulocyte count, and peripheral smear to assess for hemolysis. Decreased CO2 and increased reticulocytes suggest hemolysis.
Total Serum Protein or Albumin Level Monitoring: Monitor serum protein and albumin levels, as low levels (<3.0 g/dl protein) indicate reduced bilirubin-binding capacity.
Glucose Level Monitoring: Monitor blood glucose levels pre- and post-exchange transfusion and hourly until stable due to glucose fluctuations from donor blood and anticoagulants (Wani et al., 2018).
Platelet and WBC Count Monitoring: Monitor platelet and WBC counts for thrombocytopenia and leukopenia, potential complications of phototherapy and exchange transfusion (Sarkar et al., 2021).

Recommended Resources

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health

References and Resources

Ahmed, S. G., & Ibrahim, U. A. (2018). Heparinized blood versus citrate phosphate dextrose adenine-1 blood for exchange transfusion in neonates. Cochrane Database of Systematic Reviews, (8).
Amin, S. B., Smith, T., & Timler, G. R. (2018). Developmental and neurological outcomes after bilirubin-induced neurotoxicity. Seminars in Perinatology, 42(3), 165–172.
Aynalem, S., Abayneh, M., & Metaferia, G. (2020). Risk factors for neonatal hyperbilirubinemia in preterm and term newborns in neonatal intensive care unit at referral hospital in Southern Ethiopia: a case-control study. BMC Pediatrics, 20(1), 1–9.
Cetinkursun, S., Demirbağ, M. S., Cincik, M., Baykal, B., & Günay, I. (2006). The effects of phototherapy on newborn rat testis. Archives of Andrology, 52(1), 61–70.
Chacham, S., Kumar, P., Dutta, S., & Kumar, A. (2019). Adverse events following neonatal exchange transfusion: a prospective study. Journal of Perinatology, 39(1), 112–117.
Chen, H. N., Lee, M. L., Tsao, L. Y., Wu, K. H., & Jeng, M. J. (2008). Exchange transfusion using peripheral vessels is clinically equivalent and safer than via umbilical route for newborn infants. Pediatrics and Neonatology, 49(4), 127–131.
Gounden, V., Vashisht, R., & Jialal, I. (2021). Hypoalbuminemia. In StatPearls [Internet]. StatPearls Publishing.
Hansen, T. W., & Aslam, M. (2017). Neonatal jaundice. In Neonatology questions and controversies: core questions in neonatology (pp. 487-503). Elsevier Saunders.
Kaplan, M., Bromiker, R., Hammerman, C., Algur, N., Basel-Salmon, L., Bader, D., … & Lerner-Geva, L. (2019). Severe neonatal hyperbilirubinemia and auditory neuropathy spectrum disorder: a systematic review and meta-analysis. Archives of Disease in Childhood-Fetal and Neonatal Edition, 104(5), F511-F519.
Maya-Enero, S., Candel Monserrate, C., & Sánchez Luna, M. (2021). Transcutaneous bilirubin nomogram for risk assessment of hyperbilirubinemia in healthy late preterm and term newborns: a prospective multicenter study. European Journal of Pediatrics, 180, 1783–1792.
Morrison, K. (2021). Neonatal jaundice. Paediatrics and Child Health, 31(9), 329-335.
Poder, T. G., Nonnenmacher, C., Comte, B., Labaune, M. A., & Favrais, G. (2015). Blood warming practices during exchange transfusion in neonates: a survey of current practices and a review of the literature. Transfusion Clinique et Biologique, 22(5-6), 283–288.
Salman, M., Rathore, A. W., Mashwani, S. Z., Ansari, M. A., Khan, F. U., & Khan, A. (2021). Frequency of morbidities and mortality in late preterm versus term neonates admitted in neonatal intensive care unit. JPMA. The Journal of the Pakistan Medical Association, 71(3), 943–947.
Sardari, S., Badiee, Z., & Mamوریان, م. (2019). The effect of education on mothers’ awareness about neonatal jaundice and care-seeking behaviors in Iran: a quasi-experimental study. International Journal of Pediatrics, 7(7), 9517-9524.
Sarkar, S., Agarwal, V., & Bhatia, S. (2021). Thrombocytopenia in neonates undergoing phototherapy. Indian Journal of Hematology and Blood Transfusion, 37, 254–258.
Sawyer, T., & Nimavat, D. J. (2018). Neonatal jaundice. Pediatrics in Review, 39(11), 543–554.
Szigeti, R. G., & Staros, E. B. (2014). Evaluation of anemia in children. American Family Physician, 89(4), 271–278.
The Royal Children’s Hospital. (2004). Exchange transfusion.
Van der Walt, J. H., & Russel, W. J. (1978). Blood warming: temperature guidelines. Anaesthesia and Intensive Care, 6(3), 235–238.
Vodret, S., Štucin Gantar, I., Trošt, N., Debeljak, M., & Jurdana, M. (2015). Albumin administration during exchange transfusion for hyperbilirubinemia in neonates: a randomized controlled trial. The Journal of Pediatrics, 166(4), 856-861. e1.
Wagle, R., & Aslam, M. (2017). Neonatal exchange transfusion. In Neonatology questions and controversies: core questions in neonatology (pp. 505-514). Elsevier Saunders.
Wang, J., Guo, L., Cai, Q., & Wang, X. (2021). Adverse effects of neonatal blue light phototherapy on body temperature, skin moisture, and blood flow velocity: A systematic review and meta-analysis. Photodermatology, Photoimmunology & Photomedicine, 37(5), 383–392.