A'dam's version of Jaundice

PLAN Hyperbilirubinemia

PLAN BODY

do unordered , wait-for-optional-subplans = yes , wait-for Diagnostics-and-Treatment-hyperbilirubinemia

Check-for-rapid-TSB-increase

Check-for-jaundice-after-2-weeks

Check-for-jaundice-after-3-weeks

Diagnostics-and-Treatment-hyperbilirubinemia

PLAN Check-for-rapid-TSB-increase

PLAN BODY

do sequentially , wait-for all

possibility-of-hemolytic-disease =

if (age = day2) then possibility-of-G6PD = yes Exit-possibility-of-G6PD else possibility-of-G6PD = no Exit-possibility-of-hemolytic-disease

PLAN Exit-possibility-of-G6PD

Exit this protocol. Perform appropriate laboratory assessment (possibility of hemolytic disease, probably caused by G6PD).

PLAN BODY

user-performed

PLAN Exit-possibility-of-hemolytic-disease

Exit this protocol. Perform appropriate laboratory assessment (possibility of hemolytic disease).

PLAN BODY

user-performed

PLAN Check-for-jaundice-after-2-weeks

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for all ask physical-exam-OK ask colour-stools ask colour-urine

if (or (physical-exam-OK = no) (colour-stools = "light") (colour-urine = "dark") ) then ask direct-serum-bilirubin possibility-of-cholestatic-disease = yes Exit-possibility-of-cholestatic-jaundice else possibility-of-cholestatic-disease = no Exit-provide-routine-care

PLAN Exit-possibility-of-cholestatic-jaundice

Perform appropriate laboratory assessment, including possibility of cholestatic jaundice.

PLAN BODY

user-performed

PLAN Exit-provide-routine-care

Provide routine care, recommend routine feeding and follow-up.

PLAN BODY

user-performed

PLAN Check-for-jaundice-after-3-weeks

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for all ask TSB-value ask direct-serum-bilirubin ask total-urine-bilirubin

possibility-of-cholestatic-disease = yes

Exit-possibility-of-cholestatic-jaundice

PLAN Diagnostics-and-Treatment-hyperbilirubinemia

PLAN BODY

do sequentially , wait-for none

ask term-child

ask age-child

Diagnostics-hyperbilirubinemia

Treatment-hyperbilirubinemia

PLAN Diagnostics-hyperbilirubinemia

PLAN BODY

do sequentially , wait-for all

pathologic-reason = no

Anamnesis-abnormal-signs

Blood-tests

Anamnesis-hemolytic-disease

Jaundice-determination

PLAN Anamnesis-abnormal-signs

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for all ask lethargy ask apnea ask tachypnea ask instable-temperature ask behavior-changes ask hepatosplenomegaly ask vomitting ask feeding-difficulty ask excessive-weight-loss

if (or (lethargy = yes) (apnea = yes) (tachypnea = yes) (instable-temperature = yes) (behavior-changes = yes) (hepatosplenomegaly = yes) (vomitting = yes) (feeding-difficulty = yes) (excessive-weight-loss = yes) ) then possibility-of-other-diseases = yes else possibility-of-other-diseases = no

if (possibility-of-other-diseases = yes) then pathologic-reason = yes

PLAN Blood-tests

PLAN BODY

do sequentially , wait-for-optional-subplans = yes

Check-blood-test-mother

Perform-blood-test-child

PLAN Check-blood-test-mother

PLAN BODY

if (or (and (rhesustype-mother = positive) (serum-isoimmune-antibodies-mother = negative) ) (bloodtype-mother = O) )

then consider-holding-cord-blood = yes Consider-holding-cord-blood

else consider-holding-cord-blood = no

PLAN Consider-holding-cord-blood

Consider holding infant's cord blood in a blood bank in case future testing is necessary

PLAN BODY

user-performed

PLAN Perform-blood-test-child

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for all ask bloodtype-child ask rhesustype-child ask direct-Coombs-test

if (direct-Cooms-test = positive) then possibility-of-isoimmune-hemolytic-disease = yes else possibility-of-isoimmune-hemolytic-disease = no

if (possibility-of-isoimmune-hemolytic-disease = yes) then pathologic-reason = yes

PLAN Anamnesis-hemolytic-disease

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for all ask family-history ask ethnic-origin ask geographic-origin ask early-jaundice ask pallor ask hepatosplenomegaly

if (or (family-history = yes) (ethnic-origin = yes) (geographic-origin = yes) (early-jaundice = yes) ) then Investigate-possibility-of-hemolytic-disease ask par-possibility-of-hemolytic-disease if (par-possibility-of-hemolytic-disease = yes) then possibility-of-hemolytic-disease = yes else possibility-of-hemolytic-disease = no

if (ethnic-origin = yes) then possibility-of-inherited-disease = yes else possibility-of-inherited-disease = no

if (or (possibility-of-hemolytic-disease = yes) (possibility-of-inherited-disease = yes) ) then pathologic-reason = yes

PLAN Investigate-possibility-of-hemolytic-disease

Perform appropriate laboratory assessment of infant including (but not limited to): (1) complete blood count, differential smear, reticulocyte count; (2) G6PD screen; (3) hemoglobin electrophoresis.

PLAN BODY

user-performed

PLAN Jaundice-determination

PLAN BODY

do sequentially , wait-for all

do any-order , wait-for one Blanching-skin-with-digital-pressure-test Icterometer-test Transcutaneous-jaundice-meter-test Determine-extent-cephalocaudad-progression

ask jaundice-clinically-significant

PLAN Blanching-skin-with-digital-pressure-test

Blanching sking with digital pressure test

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Icterometer-test

Icterometer test

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Transcutaneous-jaundice-meter-test

Transcutaneous jaundice meter test

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Determine-extent-cephalocaudad-progression

Determine extent cephalocaudad progression

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Treatment-hyperbilirubinemia

PLAN BODY

do parallel , wait-for one

do any-order Regular-treatments on-abort Exchange-transfusion Exchange-transfusion

cyclical-plan

do sequentially , wait-for all ask TSB-value ask age-child

repeat-specification retry-delay min = 12h, max = 24h

PLAN Regular-treatments

PLAN BODY

do unordered , wait-for all

Feeding-alternatives

do any-order , retry-aborted-subplans = yes , wait-for Observation Phototherapy-intensive Phototherapy-normal-prescription Phototherapy-normal-recommendation Observation

PLAN Feeding-alternatives

PLAN BODY

do sequentially , wait-for all

ask breastfed-child

if (breastfed-child = yes) then Choose-feeding-alternative

PLAN Choose-feeding-alternative

PLAN BODY

do any-order , wait-for one

Breastfeeding

Breastfeeding-with-formula

Formula-only

PLAN Breastfeeding

Breastfeeding

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Breastfeeding-with-formula

Breastfeeding with formula

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Formula-only

Formula only

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Phototherapy-intensive

PLAN BODY

Prescribe-intensive-phototherapy

PLAN Prescribe-intensive-phototherapy

Prescribe intensive phototherapy

PLAN BODY

user-performed

PLAN Phototherapy-normal-prescription

PLAN BODY

Prescribe-normal-phototherapy

PLAN Prescribe-normal-phototherapy

Prescribe normal phototherapy

PLAN BODY

user-performed

PLAN Phototherapy-normal-recommendation

PLAN BODY

do any-order , wait-for one

Prescribe-observation-manual-activation

Prescribe-normal-phototherapy-manual-activation

PLAN Prescribe-observation-manual-activation

Prescribe observation

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Prescribe-normal-phototherapy-manual-activation

Prescribe normal phototherapy

CONDITIONS activate-mode = manual

PLAN BODY

user-performed

PLAN Observation

PLAN BODY

Prescribe-observation

PLAN Prescribe-observation

Prescribe observation

PLAN BODY

user-performed

PLAN Exchange-transfusion

PLAN BODY

do parallel , wait-for all

Prescribe-intensive-phototherapy

Prescribe-exchange-transfusion

PLAN Prescribe-exchange-transfusion

Prescribe exchange transfusion

PLAN BODY

user-performed