Updated Guideline on Jaundice in Newborns

The Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) has updated its clinical practice guideline on identifying and managing jaundice in newborns. “Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation” appears in the July 2004 issue of Pediatrics and is available online at http://pediatrics.aappublications.org/cgi/content/full/114/1/297.

The AAP updated its guideline to provide physicians with specific advice about treatment and to promote greater uniformity and consistency of care for all newborns. Among the new recommendations are the following:

• Physicians should perform a systematic assessment on all infants, prior to discharge, for subsequent risk of severe jaundice.

• Physicians should instruct the infant’s parents to schedule a follow-up visit at three to five days of age, when the infant’s bilirubin level is highest.

• Physicians should recommend that mothers breastfeed at least eight to 12 times a day for the first few days. This will help produce enough milk and help keep the infant’s bilirubin level down.

• Physicians should provide parents with written and oral information about newborn jaundice. A “Frequently Asked Questions” document is included with the guidelines and is available online at http://www.aap.org/family/jaundicefaq.htm.

The Centers for Disease Control and Prevention (CDC) supports the use of the revised guideline for eliminating kernicterus and hyperbilirubinemia. In 2001, the CDC reported an increase of kernicterus cases in the United States and encouraged systematic assessment of bilirubin levels in newborns before their discharge from the birth hospital, along with proper follow-up care, lactation support, and parent education about jaundice. Additional information about kernicterus is available at http://www.cdc.gov/ncbddd/dd/kernicterus.htm.