Neonatal Jaundice Management Guidelines

Risk Assessment and Screening

The American Academy of Pediatrics recommends universal risk assessment for hyperbilirubinemia in all newborns ≥35 weeks gestation before discharge, using either total serum bilirubin measurement or assessment of clinical risk factors 1
Predischarge measurement of bilirubin level using total serum bilirubin or transcutaneous bilirubin is a clinical option for risk assessment 1
Assessment of clinical risk factors, such as jaundice observed in the first 24 hours of life, blood group incompatibility, and gestational age 35-36 weeks, is also a clinical option for risk assessment 1

All infants should be examined by a qualified healthcare professional within the first few days after discharge, with follow-up timing based on discharge age 2
Earlier or more frequent follow-up is recommended for infants with risk factors, such as jaundice or blood group incompatibility 2

Follow-up assessment should include weight and percent change from birth weight, adequacy of intake, pattern of voiding and stooling, and presence or absence of jaundice 2
If there is any doubt about jaundice severity, measurement of total serum bilirubin or transcutaneous bilirubin is recommended 2

Phototherapy should be initiated based on total serum bilirubin levels that exceed thresholds on the American Academy of Pediatrics nomogram, which vary according to the infant's age in hours and risk category 3, 4
Intensive phototherapy should deliver irradiance in the blue-green spectrum of at least 30 μW·cm−2·nm−1 5
Phototherapy should be delivered to as much of the infant's surface area as possible, with irradiance measured at the infant's skin directly below the center of the phototherapy unit 6

Total serum bilirubin levels should be monitored regularly during phototherapy, with frequency of measurement based on bilirubin level 4
Phototherapy should be discontinued when total serum bilirubin level is <13-14 mg/dL 4

In breastfed infants requiring phototherapy, breastfeeding should be continued if possible, with supplementation with expressed breast milk or formula if necessary 6
Temporary interruption of breastfeeding with formula substitution is an option to reduce bilirubin levels and enhance phototherapy efficacy 6

Immediate exchange transfusion is recommended for any jaundiced infant showing signs of intermediate to advanced acute bilirubin encephalopathy, even if total serum bilirubin is falling 6
For infants with isoimmune hemolytic disease and rapidly rising total serum bilirubin despite intensive phototherapy, administration of intravenous immunoglobulin is recommended 4

Changing the infant's position during phototherapy has not been demonstrated to improve effectiveness, but using multiple phototherapy devices can be more effective 8
If total serum bilirubin does not decrease or continues to rise during intensive phototherapy, hemolysis should be suspected 6

All hospitals should provide written and verbal information for parents at discharge about jaundice, the need to monitor infants for jaundice, and advice on how monitoring should be done 2