![]() Treat newborns, when indicated, with phototherapy or exchange transfusion. Provide appropriate follow-up based on the time of discharge and the risk assessment. Provide parents with written and verbal information about newborn jaundice. Perform a systematic assessment on all infants before discharge for the risk of severe hyperbilirubinemia. Recognize that infants at less than 38 weeks’ gestation, particularly those who are breastfed, are at higher risk of developing hyperbilirubinemia and require closer surveillance and monitoring. Interpret all bilirubin levels according to the infant’s age in hours. Recognize that visual estimation of the degree of jaundice can lead to errors, particularly in darkly pigmented infants. Measure the total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) level on infants jaundiced in the first 24 hours. ![]() Promote and support successful breastfeeding.Įstablish nursery protocols for the identification and evaluation of hyperbilirubinemia. A list of frequently asked questions and answers for parents is available in English and Spanish at DEFINITION OF RECOMMENDATIONS 2 (See “An Evidence-Based Review of Important Issues Concerning Neonatal Hyperbilirubinemia” 3 for a description of the methodology, questions addressed, and conclusions of this report.) This guideline is intended for use by hospitals and pediatricians, neonatologists, family physicians, physician assistants, and advanced practice nurses who treat newborn infants in the hospital and as outpatients. 1 The current guideline represents a consensus of the committee charged by the AAP with reviewing and updating the existing guideline and is based on a careful review of the evidence, including a comprehensive literature review by the New England Medical Center Evidence-Based Practice Center. ![]() In October 1994, the Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) produced a practice parameter dealing with the management of hyperbilirubinemia in the healthy term newborn. 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). These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. Although kernicterus should almost always be preventable, cases continue to occur. ![]() 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. 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.
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