22. 2004 AAP Guidelines Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Subcommittee on Hyperbilirubinemia Pediatrics 2004; 114;297-316
Jaundice < 24 hours = pathologic; check TSB or TcB Jaundice appears excessive for age = TSB or TcB The need for and timing of a repeat bili depends on the zone in which TSB falls, age of infant Interpret all bili levels according to infant’s age in hours
Use total bili Risk factors = isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis, or albumin < 3.0 Can use home phototherapy if no risk factors Based on limited evidence Use intensive phototherapy when TSB exceeds line If TSB doesn’t decrease or rises strongly suggests hemolysis If TSB > 25 or at level recommending exchange transfusion it is a med emergency and requires admission Isoimmune hemolytic disease: IV gamma globulin (.50-1 g/kg over 2 hrs) if TSB rising on phototherapy or within 2-3 mg/dL of exchange transfusion recommendations. Can repeat dose in 12 hours. Shown to decrease need for exchange transfusion