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