MEREDITH L. PORTER, CPT, MC, USA, and 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 many common difficulties encountered in term newborns. Historically, administration guidelines were derived from research studies on bilirubin toxicity in infants via hemolytic disease. More recent recommendations support the usage of less intensive therapy in healthy and balanced term newborns through jaundice. Phototherapy should be instituted as soon as the complete 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 babies 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hrs. Few term newborns via hyperbilirubinemia have actually serious underlying pathology. Jaundice is thought about pathologic if it presents within the initially 24 hrs after birth, the complete serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is better than 17 mg per dL (290 mol per L), or an infant has signs and also symptoms suggestive of major condition. The monitoring objectives are to exclude pathologic causes of hyperbilirubinemia and initiate therapy to prevent bilirubin neurotoxicity.


Neonatal hyperbilirubinemia, defined as a complete serum bilirubin level over 5 mg per dL (86 μmol per L), is a typically encountered difficulty. Although as much as 60 percent of term newborns have actually clinical jaundice in the initially week of life, few have significant underlying condition.1,2 However, hyperbilirubinemia in the newborn period have the right to be linked through significant illnesses such as hemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections.

Jaundice typically results from the deplace of unconjugated bilirubin pigment in the skin and also mucus membranes. Depfinishing on the underlying etiology, this problem might existing throughout the neonatal duration. Unconjugated hyperbilirubinemia, the main emphasis of this post, is the most widespread form of jaundice encountered by household medical professionals. The sepaprice topic of conjugated hyperbilirubinemia is beyond the scope of this article.

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Infants without determined threat factors hardly ever have actually complete serum bilirubin levels above 12 mg per dL (205 μ mol per L). As the number of hazard determinants boosts, the potential to develop markedly elevated bilirubin levels also rises.2

Typical hazard determinants for hyperbilirubinemia include fetal-maternal blood team incompatibility, prematurity, and a formerly influenced sibling (Table 1).2–4 Cephalohematomas, bruising, and trauma from instrumented delivery might boost the threat for serum bilirubin elevation. Delayed meconium passage additionally increases the hazard. Infants via threat components need to be monitored carefully throughout the first days to weeks of life.


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

Maternal components Blood type ABO or Rh incompatibility Breastfeeding Drugs: diazepam (Valium), oxytocin (Pitocin) Ethnicity: Asian, Native American Maternal illness: gestational diabetes

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


TABLE 1Risk Factors for Hyperbilirubinemia in Newborns

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

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