Jaundice and Kernicterus Guidelines and Tools for Health Professionals

Doctor examining baby

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

From the American Academy of Pediatrics Practice Guidelines, 2004

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).

The following are the key elements of the recommendations provided by this guideline. Clinicians should:

  1. Promote and support successful breastfeeding.
  2. Establish nursery protocols for the identification and evaluation of hyperbilirubinemia.
  3. Measure the total serum bilirubin (TSB) or transcutaneous bilirubin (TcB) level on infants jaundiced in the first 24 hours.
  4. Recognize that visual estimation of the degree of jaundice can lead to errors, particularly in darkly pigmented infants.
  5. Interpret all bilirubin levels according to the infant’s age in hours.
  6. 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.
  7. Perform a systematic assessment on all infants before discharge for the risk of severe hyperbilirubinemia.
  8. Provide parents with written and verbal information about newborn jaundice.
  9. Provide appropriate follow-up based on the time of discharge and the risk assessment.
  10. Treat newborns, when indicated, with phototherapy or exchange transfusion.

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BiliTool is designed to help clinicians assess the risks toward the development of hyperbilirubinemia or “jaundice” in newborns over 35 weeks gestational age.

Use BiliTool »external icon

Page last reviewed: December 8, 2020