Born

Date	Time	Age (hr)	Bilirubin	Serum/ Meter	Nurse	Action

Maternal Blood Type: ______
Baby Blood Type: ______
Coombs: ______

Risk Factors for Severe Jaundice

[  ] Positive Coombs Test
[  ] Jaundice in the first 24 hours
[  ] Sibling with history of jaundice
[  ] 35-38 week gestation
[  ] Exclusive breastfeeding
[  ] Asian ethnicity
[  ] Extensive bruising or
     cephalohematoma