Guidelines and Tools for Health Professionals

Kernicterus in Full Term Infants

From the Centers for Disease Control and Prevention, 2001

Early hyperbilirubinemia detection is critical to the prevention of the irreversible effects of kernicterus. Health care providers, parents, and other caretakers should be aware of risk factors for hyperbilirubinemia, and treatment should begin immediately after hyperbilirubinemia is diagnosed. Verbal and written information received before the infant is discharged may be useful in gaining an understanding of risk factors for and signs and treatment of jaundice and hyperbilirubinemia. Bilirubin levels before discharge may provide quantitative measurement that could aid management. Infants discharged <48 hours after birth should be examined by a health care provider within 2 to 3 days to receive routine follow-up visits and a jaundice assessment.

Major Risk Factors for Hyperbilirubinemia in Full-Term Newborns

Jaundice within first 24 hours after birth.
A sibling who was jaundiced as a neonate.
Unrecognized hemolysis such as ABO blood type incompatibility or Rh incompatibility.
Nonoptimal sucking/nursing.
Deficiency in glucose-6-phosphate dehydrogenase, a genetic disorder.
Infection.
Cephalohematomas/bruising.
East Asian or Mediterranean descent.

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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).

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Severe Neonatal Jaundice: Causes, Care, Outcome, Prevention

From Children’s Hospital of Pittsburgh

1. Promote and support successful breastfeeding.
2. Establish nursery protocols—include circumstances in which nurses can order a bilirubin.
3. Measure TSB or TcB if jaundice occurs in the first 24 hours.
4. Do not rely on visual estimation of jaundice. This can lead to errors, particularly in darkly pigmented infants.
5. Interpret bilirubin levels according to the infant’s age in hours.
6. Note that infants <38 weeks, particularly if breastfed, are high risk.
7. Perform risk assessment before discharge.
8. Give parents written and oral information about jaundice.
9. Provide appropriate follow-up based on time of discharge and risk assessment.
10. Treat newborns, when indicated, with phototherapy or exchange transfusion.

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BiliTool

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

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