Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

TLDR

Jaundice is common in newborns, usually benign, but can lead to severe hyperbilirubinemia and potentially kernicterus if not monitored. The guideline aims to lower severe hyperbilirubinemia and bilirubin encephalopathy rates while avoiding unnecessary anxiety, breastfeeding disruption, and costs. Clinicians are advised to support breastfeeding, conduct systematic risk assessments before discharge, schedule early follow‑up, and use phototherapy or exchange transfusion when indicated to prevent severe hyperbilirubinemia and kernicterus.

Abstract

Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the potential toxicity of bilirubin, newborn infants must be monitored to identify those who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although kernicterus should almost always be preventable, cases continue to occur. These guidelines provide a framework for the prevention and management of hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians 1) promote and support successful breastfeeding; 2) perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused follow-up based on the risk assessment; and 4) when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).