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학습 자료 둘러보기 →A 22 mg/dL total serum bilirubin in a 3-day-old with poor feeding is a critical threshold. Poor feeding is a sign of bilirubin neurotoxicity, placing the newborn in a high-risk category per AAP guidelines.
The priority is to prepare for an immediate exchange transfusion. This procedure rapidly removes bilirubin and antibodies, preventing permanent kernicterus. Phototherapy is a slower process and is no longer sufficient as monotherapy.
Do not delay exchange transfusion to continue phototherapy or administer IV fluids. The presence of neurotoxicity signs like poor feeding lowers the treatment threshold, making rapid bilirubin reduction the highest priority.
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