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Discharge Neonates with presumed physiologic jaundice whose serum bilirubin levels fall below the threshold for intervention, are well appearing, able to maintain adequate hydration, and have assurance of close follow-up, may be safely discharged from the ED The AAP recommends home phototherapy as an option for neonates whose TSB level does not cross the threshold for therapeutic intervention, but in whom the rate of rise may be concerning Home phototherapy is not indicated for infants with TSB levels that are above phototherapy or exchange transfusion thresholds APPROACH Clinical Pathway for Neonates The main goal of the clinical pathway is to deliver consistent and efficient care to neonates born at greater than 35 weeks of gestational age presenting with jaundice or hyperbilirubinemia The pathway emphasizes safe and consistent use of phototherapy, in order to prevent occurrences of ABE and kernicterus ( Fig 45.3 ) The pathway does not apply to infants with congenital medical or surgical conditions, those who are not normothermic, or who are known to have elevated serum bilirubin at the time of ED presentation The bedside nurse is charged with initiating the clinical pathway, providing parents with basic education as to the goals of evaluation, and obtaining a total and fractionated serum bilirubin via heel stick (capillary blood) Once the sample is collected, the infant is placed on phototherapy Logistically, by the time the history and physical examination are completed, the result of the TSB is available, allowing the clinician to rapidly make further diagnostic and therapeutic decisions The pathway provides links to education modules for clinicians, discharge paper template that may be printed for patients, and the AAP Subcommittee on Hyperbilirubinemia manuscript Implementation of this clinical pathway has been shown to reduce time to phototherapy initiation, time to bilirubin measurement, and overall ED length of stay
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