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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 297-316

CLINICAL PRACTICE GUIDELINE

Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

Subcommittee on Hyperbilirubinemia

Jaundice 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


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The following policy statement has been revised:

Practice Parameter: Management of Hyperbilirubinemia in the Healthy Term Newborn
and
Pediatrics 94: 558-565.



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M. J. Maisels
Conflict of Interest and Purpose in Bilirubin Screening: In Reply
Pediatrics, October 1, 2004; 114(4): 1133 - 1134.
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Hyperbilirubinemia: A Comprehensive New Guideline
Journal Watch Pediatrics and Adolescent Medicine, August 9, 2004; 2004(809): 3 - 3.
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C. Lannon and A. R. Stark
Closing the Gap Between Guidelines and Practice: Ensuring Safe and Healthy Beginnings
Pediatrics, August 1, 2004; 114(2): 494 - 496.
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M. J. Maisels
Use TcB as a screening tool for jaundiced newborns
AAP News, July 1, 2004; 25(1): 9 - 13.
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S. Cash
Guideline offers direction for prompt diagnosis, treatment of hyperbilirubinemia
AAP News, July 1, 2004; 25(1): 1 - 8.
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