MEREDITH L. PORTER, CPT, MC, USA, and also BETH L. DENNIS, MAJ, MC, USA, Dewitt Army Community Hospital, Ft Belvoir, Virginia

Am Fam Physician. 2002 Feb 15;65(4):599-607.

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Hyperbilirubinemia is just one of the the majority of common troubles encountered in term newborns. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic illness. More recent referrals assistance the use of much less extensive therapy in healthy term newborns via jaundice. Phototherapy should be instituted when the full serum bilirubin level is at or above 15 mg per dL (257 mol per L) in babies 25 to 48 hrs old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and also 20 mg per dL (342 mol per L) in babies older than 72 hrs. Couple of term newborns via hyperbilirubinemia have actually serious underlying pathology. Jaundice is taken into consideration pathologic if it presents within the first 24 hrs after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is greater than 17 mg per dL (290 mol per L), or an infant has actually indicators and symptoms suggestive of major illness. The monitoring purposes are to exclude pathologic reasons of hyperbilirubinemia and also initiate therapy to proccasion bilirubin neurotoxicity.


Neonatal hyperbilirubinemia, characterized as a total serum bilirubin level over 5 mg per dL (86 μmol per L), is a generally encountered problem. Although approximately 60 percent of term newborns have clinical jaundice in the first week of life, few have actually significant underlying illness.1,2 However, hyperbilirubinemia in the newborn period deserve to be linked via serious illnesses such as hemolytic illness, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections.

Jaundice frequently outcomes from the deplace of unconjugated bilirubin pigment in the skin and mucus membranes. Depending on the underlying etiology, this condition might existing throughout the neonatal period. Unconjugated hyperbilirubinemia, the major emphasis of this short article, is the many prevalent develop of jaundice encountered by family physicians. The separate topic of conjugated hyperbilirubinemia is beyond the scope of this short article.

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Infants without identified risk factors hardly ever have actually total serum bilirubin levels above 12 mg per dL (205 μ mol per L). As the number of threat factors rises, the potential to build markedly elevated bilirubin levels additionally boosts.2

Typical threat components for hyperbilirubinemia incorporate fetal-maternal blood group incompatibility, prematurity, and a formerly affected sibling (Table 1).2–4 Cephalohematomas, bruising, and trauma from instrumented delivery might increase the risk for serum bilirubin elevation. Delayed meconium passage likewise rises the danger. Infants through risk determinants have to be monitored closely throughout the first days to weeks of life.


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

Maternal determinants Blood type ABO or Rh incompatibility Breastfeeding Drugs: diazepam (Valium), oxytocin (Pitocin) Ethnicity: Eastern, Native Amerihave the right to Maternal illness: gestational diabetes

Neonatal components Birth trauma: cephalohematoma, cutaneous bruising, instrumented delivery Drugs: sulfisoxazole acetyl through erythromycin ethylsuccinate (Pediazole), chloramphenicol (Chloromycetin) Excessive weight loss after birth Infections: TORCH Infrequent feedings Male gender Polycythemia Prematurity Previous sibling through hyperbilirubinemia


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

Maternal factors Blood type ABO or Rh incompatibility Breastfeeding Drugs: diazepam (Valium), oxytocin (Pitocin) Ethnicity: Asian, Native Amerihave the right to Maternal illness: gestational diabetes

Neonatal determinants Birth trauma: cephalohematoma, cutaneous bruising, instrumented shipment Drugs: sulfisoxazole acetyl through erythromycin ethylsuccinate (Pediazole), chloramphenicol (Chloromycetin) Excessive weight loss after birth Infections: TORCH Infrequent feedings Male sex Polycythemia Prematurity Previous sibling through hyperbilirubinemia