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Clinical risk factors for progressive and/or severe hyperbilirubinemia in newborns

Clinical risk factors for progressive and/or severe hyperbilirubinemia in newborns
Prematurity (the risk increases with each additional week below 40 weeks)
Hemolytic disorders (eg, alloimmune HDN, G6PD deficiency, other inherited hemolytic conditions)
Early-onset of jaundice (within first 24 hours after birth)
Parent or sibling who required treatment for neonatal jaundice
Family history or ancestry suggestive of an inherited hemolytic disorder (ie, G6PD deficiency, hereditary spherocytosis)
Bruising, cephalohematoma, or internal bleeding
Macrosomia in a newborn of a diabetic mother
Down syndrome
Exclusive breastfeeding (with suboptimal intake)
This table summarizes clinical risk factors that are associated with increased risk of severe and/or progressive neonatal hyperbilirubinemia. For newborns undergoing routine bilirubin screening, these risk factors are used together with the predischarge bilirubin level to assess a newborn's likelihood of subsequently developing severe hyperbilirubinemia. The risk factors listed in this table are distinct from neurotoxicity risk factors, which are used to guide treatment decisions. Prematurity and hemolytic conditions are risk factors both for progressive hyperbilirubinemia and neurotoxicity. Other risk factors for neurotoxicity include sepsis, clinical instability, and hypoalbuminemia. Refer to UpToDate's topics on neonatal hyperbilirubinemia for additional details.
HDN: hemolytic disease of the newborn; G6PD: glucose-6-phosphate dehydrogenase.
References:
  1. Kemper AR, Newman TB, Slaughter JL, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics 2022; 150:e2022058859.
  2. Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks' gestation) - Summary. Paediatr Child Health 2007; 12:401. [Reaffirmed 28 February 2018.]
  3. Muchowski KE. Evaluation and treatment of neonatal hyperbilirubinemia. Am Fam Physician 2014; 89:873.
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