This policy has been revised by the policy posted on July 1, 2004.

CLINICAL PRACTICE GUIDELINES

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Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn

PROVISIONAL COMMITTEE ON QUALITY IMPROVEMENT and SUBCOMMITTEE ON HYPERBILIRUBINEMIA

Each year approximately 60% of the 4 million newborns in the United States become clinically jaundiced. Many receive various forms of evaluation and treatment. Few issues in neonatal medicine have generated such long-standing controversy as the possible adverse consequences of neonatal jaundice and when to begin treatment. Questions regarding potentially detrimental neurologic effects from elevated serum bilirubin levels prompt continuing concern and debate, particularly with regard to the management of the otherwise healthy term newborn without risk factors for hemolysis. Although most data are based on infants with birth weights ge2500 g, "term" is hereafter defined as 37 completed weeks of gestation.

Under certain circumstances, bilirubin may be toxic to the central nervous system and may cause neurologic impairment even in healthy term newborns. Most studies, however, have failed to substantiate significant associations between a specific level of total serum bilirubin (TSB) during nonhemolytic hyperbilirubinemia in term newborns and subsequent IQ or serious neurologic abnormality (including hearing impairment). Other studies have detected subtle differences in outcomes associated with TSB levels, particularly when used in conjunction with albumin binding tests and/or duration of exposure. In almost all published studies, the TSB concentration has been used as a predictor variable for outcome determinations.

Factors influencing bilirubin toxicity to the brain cells of newborn infants are complex and incompletely understood; they include those that affect the serum albumin concentration and those that affect the binding of bilirubin to albumin, the penetration of bilirubin into the brain, and the vulnerability of brain cells to the toxic effects of bilirubin.


The following policy statement is a revision:

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
Subcommittee on Hyperbilirubinemia
Pediatrics 2004 114: 297-316. [Abstract] [Full Text] [PDF]



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 J. Am. Med. Inform. Assoc.Home page
R. N. Shiffman, C. A. Brandt, Y. Liaw, and G. J. Corb
A Design Model for Computer-based Guideline Implementation Based on Information Management Services
J. Am. Med. Inform. Assoc., March 1, 1999; 6(2): 99 - 103.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
M. J. Maisels and T. B. Newman
Predicting Hyperbilirubinemia in Newborns: The Importance of Timing
Pediatrics, February 1, 1999; 103(2): 493 - 494.
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J. C. Martinez, H. O. Garcia, L. E. Otheguy, G. S. Drummond, and A. Kappas
Control of Severe Hyperbilirubinemia in Full-term Newborns With the Inhibitor of Bilirubin Production Sn-Mesoporphyrin
Pediatrics, January 1, 1999; 103(1): 1 - 5.
[Abstract] [Full Text] [PDF]

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V. K. Bhutani, L. Johnson, and E. M. Sivieri
Predictive Ability of a Predischarge Hour-specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-term Newborns
Pediatrics, January 1, 1999; 103(1): 6 - 14.
[Abstract] [Full Text] [PDF]

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 Arch Pediatr Adolesc MedHome page
C. C. Wiley, N. Lai, C. Hill, and G. Burke
Nursery Practices and Detection of Jaundice After Newborn Discharge
Arch Pediatr Adolesc Med, October 1, 1998; 152(10): 972 - 975.
[Abstract] [Full Text] [PDF]

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 J Hum LactHome page
K. Cadwell
Bilirubin Status as an Outcome Measure in Monitoring Adherence to Baby-Friendly Breastfeeding Policies in Hospitals and Birthing Centers in the United States
J Hum Lact, September 1, 1998; 14(3): 187 - 189.
[PDF]

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T. Valaes, G. S. Drummond, and A. Kappas
Control of Hyperbilirubinemia in Glucose-6-Phosphate Dehydrogenase-deficient Newborns Using an Inhibitor of Bilirubin Production, Sn-Mesoporphyrin
Pediatrics, May 1, 1998; 101 (5): e1 - e1.
[Abstract] [Full Text] [PDF]

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D. A. Christakis and F. P. Rivara
Pediatricians' Awareness of and Attitudes About Four Clinical Practice Guidelines
Pediatrics, May 1, 1998; 101(5): 825 - 830.
[Abstract] [Full Text] [PDF]

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 Pediatr. Rev.Home page
L. F. Nazarian and W. O. Robertson
Personal Reflections on the AAP Practice Parameter on Management of Hyperbilirubinemia in the Healthy Term Newborn
Pediatr. Rev., March 1, 1998; 19(3): 75 - 77.
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L. M. Gartner, C. T. Herrarias, and R. H. Sebring
Practice Patterns in Neonatal Hyperbilirubinemia
Pediatrics, January 1, 1998; 101(1): 25 - 31.
[Abstract] [Full Text] [PDF]

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L. P. Halamek, D. K. Stevenson;, and J. M. Perlman
Kernicteric Findings at Autopsy in Two Sick Near Term Infants
Pediatrics, January 1, 1998; 101 (1): 158 - 158.
[Full Text]

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 JAMAHome page
A. F. Jerant and T. D. Epperly
Early Discharge of Newborns
JAMA, December 17, 1997; 278(23): 2066 - 2066.
[Abstract] [PDF]

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 PediatricsHome page
D. J. Madlon-Kay
Recognition of the Presence and Severity of Newborn Jaundice by Parents, Nurses, Physicians, and Icterometer
Pediatrics, September 1, 1997; 100(3): e3 - e3.
[Abstract] [Full Text] [PDF]

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D. K. Stevenson and H. J. Vreman
Carbon Monoxide and Bilirubin Production in Neonates
Pediatrics, August 1, 1997; 100(2): 252 - 259.
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M. J. Maisels and E. Kring
Early Discharge From the Newborn Nursery---Effect on Scheduling of Follow-up Visits by Pediatricians
Pediatrics, July 1, 1997; 100(1): 72 - 74.
[Abstract] [Full Text] [PDF]