Term infants who are sick or who have hemolysis require full evaluation. As a rule of
thumb, start phototherapy early, and begin preparing for exchange transfusion when
TSB reaches 15mg/dL. Any infant who is jaundiced and manifests signs of the
intermediate or advanced signs of bilirubin encephalopathy should have immediate
exchange transfusion.
Recognize that the preparation time required for a double-volume exchange transfusion
(often 4-6 hours). It is prudent to send blood for typing and cross-matching to the Blood
Bank as soon as it is recognized that an exchange is possible. Dialogue with the Blood
Bank may be essential for proper composition of the whole blood required for the
procedure.
In the outpatient management of the jaundiced infant, it is an AAP recommendation that
breastfeeding should be continued. It is also an option to temporarily interrupt
breastfeeding and substitute formula. Supplementing the breastfed infant receiving
phototherapy with expressed breast milk or formula if intake is inadequate, the weight
loss is excessive or the infant seems dehydrated.
SEIZURES
Seizures in the newborn period can present in many ways. Often presentations are not
in the classical “tonic-clonic” form and can range from asymptomatic to many other
ways such as apnea, lip smacking, staring, BP instability, cyanotic spells. Etiology