Steps of newborn bilirubin screening: | ||
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Suggested follow-up according to the newborn's predischarge bilirubin level and age at discharge | ||
How far below the phototherapy threshold is the newborn's bilirubin level? | Age at time of discharge | Suggested follow-up |
0.1 to <2 mg/dL (1 to <34 micromol/L) | <24 hours |
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≥24 hours |
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2.0 to <3.5 mg/dL (34 to <60 micromol/L) | >12 hours |
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3.5 to <5.5 mg/dL (60 to <94 micromol/L) | >12 hours |
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5.5 to <7.0 mg/dL (94 to <120 micromol/L) | <72 hours |
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≥72 hours |
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≥7.0 mg/dL (≥120 micromol/L) | <72 hours |
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≥72 hours |
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TcB: transcutaneous bilirubin; TSB: total serum or plasma bilirubin; DAT: direct antiglobulin test; G6PD: glucose-6 phosphate dehydrogenase; GA: gestational age.
* Earlier testing is warranted in patients with clinical signs or risk factors for early hyperbilirubinemia, including Rh-negative mother, positive DAT, visible jaundice at <24 hours of age, or family history of hemolytic disease (eg, G6PD deficiency, hereditary spherocytosis).
¶ Refer to separate UpToDate content for the hour-specific phototherapy thresholds for newborns with and without risk factors for neurotoxicity. In addition to GA, other risk factors for neurotoxicity include hemolytic conditions, clinical instability in the previous 24 hours, sepsis, and hypoalbuminemia.
Δ The approach to using phototherapy to treat neonatal hyperbilirubinemia is beyond the scope of this table. Refer to separate UpToDate content for details of treatment. The follow-up guidance in this table applies only to infants with bilirubin values below the phototherapy threshold (ie, newborns for whom discharge is being considered).
◊ We suggest starting phototherapy early (ie, at near-threshold TSB levels) if the newborn has clinical risk factors for progressive jaundice (eg, onset of jaundice within first 24 hours after birth, ABO or Rh incompatibility, rapidly rising bilirubin levels, or significant bruising/cephalohematoma). For newborns who lack clinical risk factors for progressive hyperbilirubinemia, treatment should be individualized depending on parent/caregiver preference. Refer to UpToDate's topics on neonatal hyperbilirubinemia for additional details.
§ Treatment with home phototherapy is an option for newborns who meet all of the following criteria:¥ For newborns with bilirubin levels that are ≥5.5 mg/dL (94 micromol/L) below the threshold for phototherapy, decisions regarding timing for outpatient follow-up and rechecking bilirubin levels are individualized based upon the clinical assessment (signs of jaundice, feeding adequacy, weight trajectory, parent/caregiver concerns). For additional details, refer to UpToDate's topic on bilirubin screening in newborns.
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