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From the Centers for Disease Control and Prevention
October 13, 2004

Availability of Revised Guidelines for Identifying and Managing Jaundice in Newborns

JAMA. 2004;292(14):1678. doi:10.1001/jama.292.14.1678
Availability of Revised Guidelines for Identifying and Managing Jaundice in Newborns

MMWR. 2004;53:590-591

The American Academy of Pediatrics has published revised guidelines for identifying and managing jaundice in newborns. Jaundice is caused by an increase in serum bilirubin concentration (i.e., hyperbilirubemia)1 and makes the skin appear yellow. Excessive hyperbilirubinemia can lead to permanent brain damage (i.e., kernicterus).1 The revised guidelines were developed to promote greater uniformity and consistency of care for all newborns. Four key recommendations were emphasized for physicians:

  • Perform a systematic assessment of all infants before their discharge from the birth hospital. This assessment will determine their risk for severe jaundice and can be performed by measuring the total serum bilirubin or transcutaneous bilirubin levels, or assessing risk factors, or both.2

  • Provide appropriate follow-up based on the time of discharge. A follow-up visit should be scheduled within 3-5 days of an infant’s birth, when the bilirubin level is likely to be highest.

  • Promote and support successful breastfeeding practices. Encourage breastfeeding at least 8-12 times a day in the first days of an infant’s life. Effective breastfeeding can reduce substantially the risk for hyperbilirubinemia.

  • Provide parents with written and oral information about the risks associated with jaundice in newborns. Information about jaundice in newborns is available at http://www.aap.org/family/jaundicefaq.htm.

CDC supports the use of these guidelines for eliminating kernicterus and hyperbilirubinemia. In 2001, CDC reported an increase of kernicterus cases in the United States2 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. Information about the revised guidelines is available at http://aappolicy.aappublications.org/cgi/content/abstract/pediatrics;114/1/297.

REFERENCES
1.
American Academy of Pediatrics.  Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation.  Pediatrics. 2004;114:297-316PubMedArticle
2.
CDC.  Kernicterus in full-term infants—United States, 1994-1998.  MMWR. 2001;50:491
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