Pediatric emergency medicine trisk 0895 0895
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FIGURE 45.2 Guidelines for exchange transfusion in infants 35 or more weeks of gestation.
Exchange transfusion is recommended if the TSB rises to these levels despite intensive
phototherapy. Bilirubin/albumin (B/A) ratio can be used together with but not in lieu of the TSB
level as an additional factor in determining the need for exchange transfusion. (Reproduced
with permission from American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.
Pediatrics 2004;114[(1):297–316. Copyright © 2004 by American Academy of Pediatrics.)
Hydration
Intravenous fluids are indicated for patients with clinical evidence of dehydration
or shock. Jaundiced infants who are able to continue enteral hydration should be
encouraged to do so, in order to diminish enterohepatic recirculation and promote
bilirubin excretion. There is no evidence that intravenous fluids significantly add
benefit beyond adequate oral hydration. The interruption or discontinuation of
breast-feeding should be discouraged, and is only appropriate in certain settings
(breast milk jaundice, exposure to toxins). Bottle-feeding expressed milk or
supplementation of formula may be required in some instances. In an infant with
poor oral intake and without contraindications, an oro- or nasogastric tube is an
option to maintain enteral feedings.
