The challenge of preventing neonatal bilirubin encephalopathy: a new nursing protocol in the well newborn nursery

Monica A. Cabra, RNC, NNP, and Jonathan M. Whitfield, MBChB

Jaundice is common in healthy newborn infants. It is the result of normal adaptive physiological processes and generally peaks in severity between 3 and 5 days after birth and then resolves over the next 7 to 10 days. When bilirubin rises to toxic levels, bilirubin encephalopathy and subsequent kernicterus can occur. Clinical estimation of jaundice severity is notoriously inaccurate. This fact coupled with early discharge of newborns, often before bilirubin levels have peaked, makes hospital-based risk assessment an essential intervention before discharge. This article describes the implementation of a new protocol using BiliChek noninvasive testing to test all infants at Baylor University Medical Center.