Jaundice affects 4 out of 5 newborns, yet acute bilirubin encephalopathy and kernicterus are rare. Following a 2009 recommendation for universal newborn predischarge bilirubin screening, the incidence of hazardous bilirubin levels of 30 mg per dL (513 μmol per L) or greater decreased across three large health systems. The American Academy of Pediatrics (AAP) updated guidelines for the diagnosis and treatment of hyperbilirubinemia in infants born at more than 35 weeks of gestation.

Preventing Isoimmune Hemolytic Disease

Hemolysis is an important cause of hyperbilirubinemia in the newborn. Blood group typing, Rh(D) typing, and antibody screening should be performed early in pregnancy to determine the need for Rh(D) immune globulin and prevent isoimmune hemolytic disease of the newborn.

If screening was not performed during pregnancy, a maternal blood type and antibody screen should be obtained at admission. If the maternal antibody screen is positive or unknown at birth, a direct antiglobulin test and blood typing should be performed on the infant as soon as possible. Infants with negative direct antiglobulin test results are not at elevated risk and may be managed with usual care. Infants with a positive direct antiglobulin test are at increased risk of hemolysis and hyperbilirubinemia neurotoxicity unless their mother received Rh(D) immune globulin during pregnancy, because the immune globulin treatment can cause the positive direct antiglobulin test.