Interruption of breastfeeding and substitution of formula can reduce bilirubin levels, but optimal breastfeeding eight to 12 times per day increases removal of bilirubin through the gastrointestinal tract and ensures continued breastfeeding. Infants with inadequate oral intake, excessive weight loss more than 12 percent of birth weight , or dehydration should receive supplemental breast milk or formula; supplementation with water or dextrose water is not recommended.
Intravenous fluids should be given if feeding is unsuccessful and the infant is dehydrated. The physician should consider TSB measurements, the infant's age in hours, and the presence of risk factors to determine when to initiate phototherapy Figure 3 2 and exchange transfusion Figure 4 2.
Home phototherapy can be considered for infants at risk of reaching the threshold for intensive phototherapy. Every hospital that cares for newborns should be able to provide intensive phototherapy i. Frequency of TSB monitoring during intensive phototherapy is determined by previous measurements Table 5 2.
Discontinue phototherapy; consider rebound TSB level 24 hours after discontinuation. Information from reference 2. The infant should be transferred to a neonatal intensive care unit for immediate intensive phototherapy and consideration of exchange transfusion. Exchange transfusion should be performed immediately in any infant with jaundice and signs of acute bilirubin encephalopathy. Initial symptoms include poor feeding, hypotonia, and lethargy.
Worsening bilirubin encephalopathy is characterized by irritability and hypertonia, at times alternating with lethargy. Symptoms of severe bilirubin encephalopathy include hypertonia, arching, retrocollis, opisthotonos, fever, and high-pitched cry. Only trained personnel in a neonatal intensive care unit should perform exchange transfusion.
Administration of intravenous gamma globulin is an alternative in infants with isoimmune hemolytic disease dose: 0. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Moerschel received her medical degree from the Loyola University Chicago Ill. Stritch School of Medicine and completed her postgraduate training at the Children's Hospital of Philadelphia. Byrd Health Sciences Center. Address correspondence to Sarah K.
Reprints are not available from the authors. Treating acute bilirubin encephalopathy—before it's too late. Contemp Pediatr. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.
Watchko JF. Vigintiphobia revisited. Bryla DA. Randomized, controlled trial of phototherapy for neonatal hyperbilirubinemia. Development, design, and sample composition. Joint Commission on Accreditation of Healthcare Organizations. Kernicterus threatens healthy newborns. Accessed November 8, Gowen CW Jr. Yamauchi Y, Yamanouchi I. Breast-feeding frequency during the first 24 hours after birth in full-term neonates. Frequency of breast-feeding and serum bilirubin concentration.
Am J Dis Child. Effects of water supplementation on physiological jaundice in breast-fed babies. Arch Dis Child. Accuracy of clinical judgment in neonatal jaundice. Arch Pediatr Adolesc Med. Noninvasive measurement of total serum bilirubin in a multiracial pre-discharge newborn population to assess the risk of severe hyperbilirubinemia. New transcutaneous jaundice device with two optical paths.
J Perinat Med. Evaluation of a new transcutaneous bilirubinometer. A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward. Acta Paediatr. Transcutaneous bilirubin measurement: a multicenter evaluation of a new device. Agency for Healthcare Research and Quality.
Management of neonatal hyperbilirubinemia. Rockville, Md. When you're at home with your baby, look out for yellowing of their skin or the whites of their eyes. Gently pressing your fingers on the tip of their nose or on their forehead can make it easier for you to spot any yellowing. You should also check your baby's urine and poo. Your baby may have jaundice if their urine is yellow a newborn baby's urine should be colourless or their poo is pale it should be yellow or orange.
Speak to your midwife, health visitor or GP as soon as possible if you think your baby may have jaundice. Jaundice is an emergency if the baby has a fever, has become listless, or is not feeding well. Jaundice may be dangerous in high-risk newborns. Jaundice is generally NOT dangerous in babies who were born full term and who do not have other medical problems.
Call the infant's provider if:. Talk with your baby's provider if you have questions. In newborns, some degree of jaundice is normal and probably not preventable. The risk for serious jaundice can often be reduced by feeding babies at least 8 to 12 times a day for the first several days and by carefully identifying infants at highest risk. All pregnant women should be tested for blood type and unusual antibodies. If the mother is Rh negative, follow-up testing on the infant's cord is recommended.
This may also be done if the mother's blood type is O positive. Careful monitoring of all babies during the first 5 days of life can prevent most complications of jaundice.
This includes:. Jaundice of the newborn; Neonatal hyperbilirubinemia; Bili lights - jaundice; Infant - yellow skin; Newborn - yellow skin. Hematology and oncology. Philadelphia, PA: Elsevier; chap Neonatal jaundice and liver diseases. Kliegman RM, St. Digestive system disorders. In: Kliegman RM, St. Nelson Textbook of Pediatrics.
The neonate. Gabbe's Obstetrics: Normal and Problem Pregnancies. Updated by: Neil K. Editorial team. Newborn jaundice. It is normal for a baby's bilirubin level to be a bit high after birth. Two types of jaundice may occur in newborns who are breastfed.
Data source: Local data collection. Process a Proportion of babies with suspected jaundice who are more than 24 hours old who have their bilirubin level measured. Numerator — the number in the denominator having their bilirubin level measured. Denominator — the number of babies with suspected jaundice who are more than 24 hours old. What the quality statement means for different audiences Service providers ensure adequate access to bilirubin measurement and have local education and protocols in place that enable healthcare professionals to measure, within 6 hours, bilirubin levels in babies with suspected jaundice who are more than 24 hours old.
Source guidance Jaundice in newborn babies under 28 days. Within 6 hours The 6-hour timeframe begins when a healthcare professional suspects jaundice or when a parent or carer reports possible jaundice.
Transcutaneous bilirubinometer A device that uses reflected light to measure the yellow colour bilirubin level in the skin. Equality and diversity considerations Some parents or carers may find it difficult to access postnatal care for their baby after discharge from hospital; for example, they may be unable to afford to travel to their local clinic or hospital.
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