MEREDITH L. PORTER, CPT, MC, USA, and also BETH L. DENNIS, MAJ, MC, USA, Dewitt Military 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 a lot of common problems encountered in term newborns. Historically, monitoring guidelines were obtained from researches on bilirubin toxicity in infants with hemolytic disease. More recent references support the usage of much less intensive therapy in healthy and balanced term newborns with jaundice. Phototherapy need to be instituted as soon as the complete serum bilirubin level is at or over 15 mg per dL (257 mol per L) in babies 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hrs old, and also 20 mg per dL (342 mol per L) in infants older than 72 hours. Couple of term newborns through hyperbilirubinemia have actually significant underlying pathology. Jaundice is taken into consideration pathologic if it presents within the initially 24 hrs after birth, the full 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 signs and also symptoms suggestive of significant illness. The management objectives are to exclude pathologic causes of hyperbilirubinemia and also initiate treatment to prevent bilirubin neurotoxicity.


Neonatal hyperbilirubinemia, defined as a total serum bilirubin level above 5 mg per dL (86 μmol per L), is a frequently encountered problem. Although approximately 60 percent of term newborns have actually clinical jaundice in the initially week of life, few have actually significant underlying condition.1,2 However before, hyperbilirubinemia in the newborn period have the right to be connected with significant illnesses such as hemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and also infections.

Jaundice commonly outcomes from the deposition of unconjugated bilirubin pigment in the skin and also mucus membranes. Depfinishing on the underlying etiology, this condition might current throughout the neonatal duration. Unconjugated hyperbilirubinemia, the main emphasis of this write-up, is the a lot of widespread develop of jaundice encountered by family physicians. The sepaprice topic of conjugated hyperbilirubinemia is past the scope of this write-up.

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Infants without figured out threat determinants seldom have actually full serum bilirubin levels above 12 mg per dL (205 μ mol per L). As the number of risk factors boosts, the potential to construct markedly elevated bilirubin levels likewise boosts.2

Common risk determinants for hyperbilirubinemia incorporate fetal-maternal blood group incompatibility, prematurity, and a previously affected sibling (Table 1).2–4 Cephalohematomas, bruising, and also trauma from instrumented delivery may rise the threat for serum bilirubin elevation. Delayed meconium passage also rises the risk. Infants through danger components should be monitored closely during the initially days to weeks of life.


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

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

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


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

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

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