Increased unconjugated (indirect) bilirubin
  • Hemolysis
  • Decreased conjugation
    • Gilbert’s syndrome
    • Sepsis
    • Neonatal jaundice
Increased conjugated (direct) bilirubin
  • Hepatocellular disease
    • Hepatitis
    • Cirrhosis
    • Sepsis
  • Obstruction
    • Tumor
    • Infection
    • Stone
  • CHF

Admit Orders: Hyperbilirubinemia

1. Admit to:
2. Diagnosis: Hyperbilirubinemia.
3. Condition: Guarded.
4. Vital Signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, daily weights, monitor skin color, monitor for lethargy and hypotonia.
7. Diet:
8. IV Fluids: Isotonic fluids at maintenance rate (100-150 mL/kg/day). Encourage enteral feedings if possible, Hold Breast feeding.
9. Special Medications:
  -Phenobarbital 5 mg/kg/day PO/IV q12-24h [elixir: 15 mg/5mL, 20 mg/5mL; inj: 30 mg/mL, 60 mg/mL, 65 mg/mL, 130 mg/mL].
  -Phototherapy if bilirubin level is above 15-20 mg/dL. Bili-Blanket
  -Exchange transfusion for severely elevated bilirubin.
10. Symptomatic Medications:
11. Extras and X-rays:
12. Labs: Total bilirubin, indirect bilirubin, albumin, CMP, CBC, reticulocyte count, blood smear. Blood group typing of mother and infant, a direct Coombs’ test. In infants of Asian or Greek descent, glucose-6-phosphate dehydrogenase (G6PD) should be measured.