A nurse is educating the parents of a newborn who has hypoglycemia about how to feed their baby.

The nurse should instruct the parents to do which of the following actions?

Transcutaneous bilirubin measurement is a useful screening tool for neonatal hyperbilirubinemia, but it has some limitations and sources of variability.Therefore, any bilirubin screening result obtained must be confirmed by a diagnostic method before treatment.

Choice A is wrong because initiating phototherapy without confirming the bilirubin level could expose the newborn to unnecessary treatment and potential adverse effects.

Choice C is wrong because increasing hydration by feeding more frequently may not be sufficient to lower the bilirubin level if it is too high or if there are other causes of jaundice.

Choice D is wrong because reassuring the parent that this is a normal finding could delay the diagnosis and treatment of severe neonatal hyperbilirubinemia, which can lead to serious complications such as kernicterus spectrum disorders.

Normal ranges for transcutaneous bilirubin measurement vary depending on the device used, the skin pigmentation, and the postnatal age of the newborn.However, a general guideline is that a measurement of 16 mg/dL at 48 hours of age is above the 95th percentile and warrants further investigation.

All of the above factors increase the risk of hyperbilirubinemia in this newborn.Hyperbilirubinemia is a condition of high levels of bilirubin in the blood that can cause jaundice and brain damage.

Choice A is wrong because prematurity is a risk factor for hyperbilirubinemia, especially in babies born before 38 weeks of gestation.Premature babies have immature livers that are less able to process bilirubin and eliminate it from the body.

Choice B is wrong because breastfeeding is a risk factor for hyperbilirubinemia, particularly in some breast-fed babies who do not get enough milk or calories.Breastfeeding can also cause increased enterohepatic circulation of bilirubin, which means that bilirubin is reabsorbed from the intestines into the bloodstream instead of being excreted in the stool.

Choice C is wrong because Asian ethnicity is a risk factor for hyperbilirubinemia, as some Asian populations have higher rates of glucose-6-phosphate dehydrogenase deficiency, a genetic condition that causes red blood cells to break down more easily and release more bilirubin.Asian infants may also have lower levels of uridine diphosphate glucuronosyltransferase, an enzyme that helps convert bilirubin into a form that can be excreted by the liver.

Normal ranges for bilirubin levels vary depending on the age, weight, and health status of the newborn.Generally, bilirubin levels peak between the third and seventh day after birth and then decline gradually.The AAP recommends using a nomogram based on the infant’s age in hours and serum bilirubin level to determine the risk of severe hyperbilirubinemia and the need for treatment.Treatment options include phototherapy and exchange transfusion.