A nurse is teaching a parent about how to prevent physiologic jaundice in a breastfed newborn.

Which of the following instructions should the nurse include?

This is because breastfeeding frequently can help the newborn pass more stools, which contain bilirubin, and reduce the risk of jaundice.

Choice A is wrong because supplementing breastfeeding with glucose water can reduce the amount of breast milk intake and increase the risk of jaundice.

Choice B is wrong because exposing the newborn to natural sunlight for short periods has not been proven to be effective in preventing or treating jaundice.

Moreover, sunlight can cause sunburn and dehydration in newborns.

Choice D is wrong because it includes choices A and B, which are incorrect.

Physiologic jaundice is a common and harmless condition that occurs in newborns due to the immature liver function and increased breakdown of red blood cells.It causes yellow discoloration of the skin and eyes due to the accumulation of bilirubin, a yellow pigment of red blood cells.Physiologic jaundice usually appears between the second and fourth day after birth and resolves within one to two weeks.Normal ranges of bilirubin levels vary depending on the age, gestational age, and health status of the newborn, but generally they are below 5 mg/dL (86 micromol/L) at term.

This is because phototherapy exposes the newborn to a special blue-to-green light that lowers the serum bilirubin level by transforming it into water-soluble isomers that can be eliminated without liver conjugation.However, this light can also damage the newborn’s eyes and cause retinal injury or blindness, so it is important to protect them with a mask.

Choice A is wrong because applying lotion to the newborn’s skin before phototherapy can interfere with the light penetration and reduce the effectiveness of the treatment.

It can also cause skin irritation or allergic reactions.

Choice B is wrong because removing the newborn from phototherapy every 4 hours can interrupt the continuous exposure to the light and delay the reduction of bilirubin levels.

The newborn should only be removed from phototherapy for feeding, diaper changes, and physical examination.

Choice D is wrong because placing the newborn on a radiant warmer during phototherapy can increase the risk of dehydration, hyperthermia, and skin burns.

The newborn should be monitored for temperature and fluid balance during phototherapy and kept in a crib or bassinet with a blanket.