Management of Hyperbilirubinemia

in the newborn infant 35 or more weeks of gestation

Clinical Practice Guideline American Academy of Pediatrics

BILIRUBIN ............................................

By-product of heme metabolism

Excreted through stool and urine Fat-soluble Hyperbilirubinemia

JAUNDICE ............................................

Yellowish discoloration of the skin and sclera

Common in most newborn infants

Benign but has potential for bilirubin toxicity = KERNICTERUS

Risk factors Management

KEY ELEMENTS
1

Promote and support successful breastfeeding

Establish protocols in the the identification and evaluation of hyperbilirubinemia Measure the total serum bilirubin(TSB) or transcutaneous bilirubin (TcB) level on infants jaundiced within 24 hours

KEY ELEMENTS
4 Recognize that visual estimation of the degree of jaundice can lead to errors, particularly in darkly pigmented infants
5 Interpret all bilirubin levels in infant's age in hours 6

Recognize that infants at less than 38 weeks' particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia

KEY ELEMENTS
7

Perform a systematic assessment on all infants before discharge for the risk of severe hyperbilirubinemia
Provide parents with a written and verbal information about newborn jaundice Provide appropriate follow-up based on time of discharge and the risk assessment

Risk factors for development of Severe Hyperbilirubinemia

............................................

Pre-discharge TSB in the high-risk zone Jaundice observed in the first 24 hours Blood group incompatibility Prematurity Cephalohematoma or significant bruising Exclusive breastfeeding East Asian race Previous sibling received phototherapy

Follow-up should be provided as follows: ............................................

Infant Discharged
Before age 24 hours Between 24 48 hours Between 48- 72 hours
Should be seen by age

72 hours 96 hours 120 hours

KEY ELEMENTS
10

Treat newborns, when indicated with phototherapy or exchange transfusion

SUMMARY
1

Promote and support successful breastfeeding

Perform a systematic assessment before discharge for the risk of hyperbilirubinemia

SUMMARY
3

Provide early and focused follow-up based on the risk assessment

Treat newborns with phototherapy or exchange transfusion when indicated

Thank you!

PRACTICAL TIPS
1 Cover BOTH eyes and genitals for

males. Cover only the eyes for females 2 Phototherapy must be at least 12 inches away from the chest 3 Turn at least 2 3 hours to expose the back and sides 4 Cepahlo-caudal progression 5 Remember bilirubin levels are interpreted in HOURS

ANSWERS
1. 35 or more weeks of gestation

............................................

2-3. 12 inches away from the infant's body; eyes and genital with protective covering 4. 72 hours 5-6. Bilirubin > 25 mg/ml; bilirubin levels not decreasing despite intensive phototherapy

7-10. RISK FACTORS for developing Severe Hyperbilirubinemia