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CLINICAL PRACTICE GUIDELINE |
Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
Subcommittee on HyperbilirubinemiaJaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).
Key Words: hyperbilirubinemia • newborn • kernicterus • bilirubin encephalopathy • phototherapy
Abbreviations: AAP, American Academy of Pediatrics • TSB, total serum bilirubin • TcB, transcutaneous bilirubin • G6PD, glucose-6-phosphate dehydrogenase • ETCOc, end-tidal carbon monoxide corrected for ambient carbon monoxide • B/A, bilirubin/albumin • UB, unbound bilirubin
The following policy statement is a revision:
- Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
- Vinod K. Bhutani and the Committee on Fetus and Newborn
Pediatrics 2011 128: e1046-e1052.[Abstract] [Full Text] [PDF]
The following policy statement has been revised:
- Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn
- PROVISIONAL COMMITTEE ON QUALITY IMPROVEMENT SUBCOMMITTEE ON HYPERBILIRUBINEMIA
Pediatrics 1994 94: 558-565.[Abstract] [PDF]
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C. E. Mercier, S. E. Barry, K. Paul, T. V. Delaney, J. D. Horbar, R. C. Wasserman, P. Berry, and J. S. Shaw Improving Newborn Preventive Services at the Birth Hospitalization: A Collaborative, Hospital-Based Quality-Improvement Project Pediatrics, September 1, 2007; 120(3): 481 - 488. [Abstract] [Full Text] [PDF]
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K. Ives Preventing kernicterus: a wake-up call Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2007; 92(5): F330 - F331. [Full Text] [PDF]
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D. Manning, P. Todd, M. Maxwell, and M. Jane Platt Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2007; 92(5): F342 - F346. [Abstract] [Full Text] [PDF]
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M. F. B. de Almeida and C. M. Draque Neonatal Jaundice and Breastfeeding NeoReviews, July 1, 2007; 8(7): e282 - e288. [Abstract] [Full Text] [PDF]
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L. A. Steiner, M. J. Bizzarro, R. A. Ehrenkranz, and P. G. Gallagher A Decline in the Frequency of Neonatal Exchange Transfusions and Its Effect on Exchange-Related Morbidity and Mortality Pediatrics, July 1, 2007; 120(1): 27 - 32. [Abstract] [Full Text] [PDF]
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P. A. Dennery and S. Lorch Neonatal Blue-Light Phototherapy Could Increase the Risk of Dysplastic Nevus Development Pediatrics, July 1, 2007; 120(1): 247 - 248. [Full Text] [PDF]
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K. B. Kolman, K. M. Mathieson, and C. Frias A Comparison of Transcutaneous and Total Serum Bilirubin in Newborn Hispanic Infants at 35 or More Weeks of Gestation J Am Board Fam Med, May 1, 2007; 20(3): 266 - 271. [Abstract] [Full Text] [PDF]
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M. Gomez, C. Bielza, J. A. Fernandez del Pozo, and S. Rios-Insua A Graphical Decision-Theoretic Model for Neonatal Jaundice Med Decis Making, May 1, 2007; 27(3): 250 - 265. [Abstract] [PDF]
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 M. Sgro, D. Campbell, and V. Shah Coombs' testing and neonatal hyperbilirubinemia Can. Med. Assoc. J., March 27, 2007; 176(7): 973 - 973. [Full Text] [PDF]
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