Hyperbilirubinemia is a state where human blood has too much bilirubin. Bilirubin is produced when the liver breaks down old red blood cells, and the color of this substance is brownish yellow.

It is difficult for infants to dispose of bilirubin. Consequently, the substance can upsurge in their blood cells, tissues, and fluids. When this happens, the condition is called hyperbilirubinemia.

Due to the color of bilirubin, the skin and parts of the eyes can turn a yellow color, and this condition is known as jaundice.

What Is Neonatal Jaundice?

Neonatal jaundice (neonatal hyperbilirubinemia) occurs when the level of bilirubin in newborns exceeds 85 umol/l (5 mg/dL). You can notice the existence of neonatal jaundice on an infant when the face color turns yellow. Commonly, the yellow color also spreads down to the chest, belly area, legs, and soles of the feet.

Statistics show that about 60% of term newborns (infant born at a gestational age between 37 and 42 completed weeks) and 80% of premature babies develop jaundice.

Most cases of jaundice are not dangerous, but newborn infants must be observed to recognize those who might acquire severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus.

What Is Acute Bilirubin Encephalopathy?

If a newborn has severe jaundice, there is a possibility that the bilirubin passes into the brain. This condition is called acute bilirubin encephalopathy, and because bilirubin is toxic to the cells of the brain, it can be dangerous.

This is the reason why assessing and managing hyperbilirubinemia in the newborn is critical, and this is where the role of neonatal nurses is needed.

Acute Bilirubin Encephalopathy Symptoms

Here are several symptoms of acute bilirubin encephalopathy which usually appear after the first week of life:

• High-pitched crying
• Lacking of energy
• Inferior sucking
• Fever
• Vomiting
• Arching of the neck and body backwards

Kernicterus

Kernicterus occurs when acute bilirubin encephalopathy causes permanent damage to the brain. The syndrome can affect premature infants and, very rarely, term infants in the absence of profound hyperbilirubinemia.

Several signs of kernicterus are:

• Uncontrolled involuntary muscle movements
• Sensorineural (high-frequency) hearing loss
• Mental deficiency
• Muscle stiffness
• Brain enlargement
• Speech difficulties
• Seizures

Neonatal Nurse and Prevention of Acute Bilirubin Encephalopathy (ABE)

In the prevention of ABE and kernicterus, appropriate efforts must be done by neonatal nurses, and therefore being proactive is compulsory. The most vital involvement of neonatal nurses in assessing and managing hyperbilirubinemia in newborns is screening.

Here are some important points for neonatal nurses regarding the matter:

• Universal screening can be done using TSB or TcB measurements
• Always educate all families about neonatal jaundice through verbal and written information
• Keep discovering strategies within their institutions and practices to improve the processes of diagnosing and managing hyperbilirubinemia
• Bilirubin levels must be figured out according to the infant’s age in hours

The risk of kernicterus in infants with TSB greater than 30 mg/dL is about 14% and the National Quality Forum (at the Agency for Healthcare Research for Quality)  declared kernicterus and TSB concentrations greater than or equal to 30 mg/dL to be inexcusable outcomes in a health care setting.

As a neonatal nurse, you should be aware of the development of ABE and kernicterus when these conditions arise:

• Newborns with 35–36 weeks’ gestational age
• Newborns with signals of insufficient breast‐feeding or dehydration
• Newborns whose siblings had jaundice
• Newborns with predischarge TSB or TcB in the high‐risk zone
• Newborns with jaundice observed in the first 24 hours
• Newborns with isoimmune or other hemolytic disease (e.g., glucose‐6‐phosphate dehydrogenase [G6PD] deficiency)
• Newborns with significant bruising or cephalhematoma
• East Asian or Mediterranean newborns

Additionally, regular breast-feeding up to 8-12 times a day must be encouraged, as this can reduce the occurence of severe hyperbilirubinemia.

Treating ABE and Kernicterus

When ABE or kernicterus is diagnosed, the recommended treament is by applying phototherapy or exchange transfusions. That’s why all nurseries must have the adequate equipment for intensive phototherapy. Infants who are treated by phototherapy should be breast-fed, if possible.

What is the difference between a neonatal nurse and a neonatal nurse practitioner (NNP)?

A neonatal nurse is simply a registered nurse who provides nursing care for newborn.

A neonatal nurse practitioner (NNP) is an acute care practitioner who works in the neonatal intensive care unit (NICU). NICU deals with infants who have life‐threatening conditions.

How long does it take to become a neonatal nurse practitioner?

Let’s break it down. Here are the steps required to become an NNP, and the time needed to complete each step:

1. Attain a Baccalaureate of Science in Nursing (BSN) degree – 4 years
2. Get employed in NICU as a registered nurse for at least 2 years
3. Attain a Master of Science in Nursing (MSN) – 3 years

So, it takes about 9 years of education and work experience to become an NNP. In the future, it might take longer, because you will be required to have a Doctor of Nursing Practice (DNP) degree to become an NNP.

What colleges offer a program where I can finally graduate as a neonatal nurse practitioner?

We have collected a list of schools where yo can attain an MSN or DNP degree. Please visit our NNP Programs page.

How much more does a neonatal nurse practitioner make?

As we mentioned in our page about salary, based on the statistics from the U.S. Bureau of Labor Statistics, an NNP can earn 1.5 to 2 times bigger than a neonatal nurse. The more experienced an NNP, the higher the salary.

In which state are neonatal nurse practitioners paid the most?

According to statistics from the U.S. Bureau of Labor Statistics, NNPs are paid the most in Mississippi. California and Alabama follow behind. But you have to remember that each state also has its cost of living index.

For example, eventhough you are paid well as an NNP in California, the state has a very high cost of living. Mississippi and Alabama have lower cost of living than the average of U.S. states.

Can an advanced practice nurse (APN) who is not NNP functions in the NNP role to fill vacant positions in NICU?

No, she can’t.

An APN is a primary care nurse practitioner who received formal education on comprehensive primary care. She never received any specialist formal education on the subject of neonatal nursing, which is very necessary to care for critically ill and convalescing infants.

According to the National Associaton of Neonatal Nurses, the very least of NNP curriculum must have 200 neonatal‐specific didactic hours plus a minimum of 600 precepted clock hours with critically ill newborns in level II or level III NICUs.

What is the difference between neonatal nurse practitioner and neonatologist?

They are very different.

First of all, a neonatologist is a physician (MD or DO) practicing neonatology (see: Neonatology) who went for pre-med (4 years), then medical school (4 years), then pediatric residency (3 years) and neonatal fellowship (3 years).

After finishing all of these education programs, a neonatologist become an attending physician who oversees the management of care of the patients on the unit. A neonatologist commonly performs very little hands-on care.

On the other hand, working as an NNP is very task based. As an NNP, you will be definitely more bedside-oriented than a neonatologist.

As you might already know, a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) is required to become a neonatal nurse practitioner. Below we have collected a list of schools by state, which have the best neonatal nurse practitioner programs in the U.S…

Master of Science in Nursing (MSN)

Commonly, to obtain this degree, you must have at least 2 years of experience as a registered nurse in a Level III (or equivalent) NICU within the last 5 years.

Alabama

University of Alabama (UAB) School of Nursing, Birmingham

University of South Alabama, Mobile

California

University of California, San Fransisco

California State University, Long Beach

Colorado

Regis University, Denver

Connecticut

University of Connecticut, Storrs – they are planning to add a Neonatal Acute Care specialty track

Florida

University of Florida, Gainesville

Louisiana

Louisiana Statue University (LSUHSC), New Orleans

Massachusetts

Northeastern University, Boston

Michigan

Wayne State University, Detroit

Missouri

University of Missouri-Kansas City (UMKC), Kansas City

North Carolina

Duke University School of Nursing (DUSON), Durham

East Carolina University, Greenville

New York

University of Rochester, Rochester

Stony Brook University, Stony Brook

Pennsylvania

University of Pennsylvania, Philadelphia

South Carolina

Medical University of South Carolina, Charleston

Tennessee

Vanderbilt University, Nashville

Texas

Baylor University, Dallas

Washington

University of Washington, Seattle

West Virginia

West Virginia University, Morgantown

Canada

University of British Columbia (UBC), Vancouver

Doctor of Nursing Practice (DNP)

Alabama

University of Alabama School of Nursing, Birmingham

University of South Alabama College of Nursing, Mobile

Arizona

Arizona State University, Phoenix

Colorado

University of Colorado Colorado Springs (UCCS) Beth-El College, Colorado Springs

Connecticut

University of Connecticut, Storrs

Illinois

Rush University, Chicago

University of Illinois, Chicago

Iowa

University of Iowa, Iowa City

Missouri

University of Missouri-Kansas City, Kansas City

New York

Columbia University School of Nursing (CUSON) , New York

Stony Brook University, Stony Brook

North Carolina

Duke University School of Nursing (DUSON), Durham

Ohio

Case Western Reserve University, Cleveland

Pennsylvania

University of Pittsburgh, Pittsburgh

Thomas Jefferson University, Jefferson School of Nursing, Philadelphia

South Carolina

Medical University of South Carolina, Charleston

Tennessee

University of Tennessee Health Science Center College of Nursing, Memphis

Vanderbilt University, Nashville

Washington

University of Washington, Seattle

West Virginia

West Virginia University, Morgantown

• Region
• Experience
• Education
• Company size
• Industry
• Skills and specialties

Nature of Work

As a neonatal nurse, you can work in a hospital like most do, or have a position in the community, providing home care. In a hospital, you can work in a Level II nursery, with less critically ill infants, or in a Level III nursery, with the most acutely ill infants.

A Level III nursery is commonly known as neonatal intensive care unit (NICU). In a NICU, you might care for one to four infants, and should expect to work extra hard, because patients must be treated around the clock, and even on weekends and holidays.

Most neonatal nurses work 8 to 12-hour day or night shifts. If you work on nights and weekends, you will receive additional compensation.

This information should help you understand better a neonatal nurse’s nature of work, and different conditions can certainly affect the salary significantly.

If you want to know a neonatal nurse salary in your region, you can contact several hospitals where you are interested in working.

Here are some statistics for neonatal nurse salary in the United States…

Neonatal Nurse Salary

According to the Bureau of Labor Statistics, in 2010, the lowest annual salary for registered nurses (including neonatal nurses) is $44,190 and the highest can exceed $95,000. Most registered nurses earn $67,720 every year.

We cannot retrieve the salary of neonatal nurses from the Bureau of Labor Statistics (BLS), because they present the data as a whole for registered nurses. However, we think neonatal nurse salary is more or less the same, unlike neonatal nurse practitioner (NNP) salary which is definitely higher.

Neonatal Nurse Practitioner (NNP) Salary

For neonatal nurse practitioners (NNPs) with less experience, the average annual salary is $80,242. For more experienced nurses, the average annual salary is $91,000-$101,000. We collected this data from various sources and actual reports from employees in various states in 2011.

Salary by State

- Top paying states for neonatal nurse practitioners (NNPs) in 2011 -

Salary and Cost of Living

Many people who pursue better salary often forget to include the cost of living index, when looking for the highest-paying states for NNPs. So, if you are looking for a state with a better neonatal nurse salary, don’t forget to find out its cost of living too.

As you can see above, Mississippi is the top paying state for NNPs. Cost of living is also lower in this Mississippi, compared to the average cost of living in other states.

California and Alabama are the 2nd and 3rd top paying states for this career, but Alabama can be a better choice due to its low cost of living. You should remember that the cost of living in California is about 1.5 times higher than Mississippi and Alabama.

Other Statistics

Our latest data shows that in the United States, about 60% of NNPs work in companies with less than 500 employees, 17% in companies with 1,000-7,500 employees, and 20% in companies with more than 15,000 employees. Our record also indicates that the smaller the company size, the higher the salary tends to be.

About 13% of NNPs in the U.S. have a DNP degree and the rest have Master’s. Read also neonatal nurse practitioner programs.