Bilirubin may be toxic to the brainstem. In jaundiced term infants who do not have
hemolysis, an association that might exist between any one total serum bilirubin (TSB)
level and later serious neurologic abnormality of hearing deficit remains unproven.
There is some evidence, however, that subtle differences in outcome might be linked to
TSB levels.
The goal is to reduce the incidence of severe hyperbilirubinemia as well as acute
bilirubin encephalopathy (the clinical central nervous system findings associated with
bilirubin toxicity) and the more chronic kernicterus while minimizing harm such as
increased parental anxiety, decreased breastfeeding and unnecessary costs and
treatments.
AAP GUIDELINES RECOMMEND
The promotion and support of successful breastfeeding, the measurement of total
serum bilirubin or transcutaneous bilirubin in any infant jaundiced within the first 24
hours of life, recognizing that visual estimation of the degree of jaundice can lead to
errors, interpret bilirubin levels according to the infant’s age in hours, recognize that
infants born at less than 38 weeks gestation, especially if breastfed are at a higher risk
for hyperbilirubinemia, perform systematic review of risk factors for hyperbilirubinemia in
all infants prior to discharge, especially if discharge takes place before age of 72 hours,
arrange appropriate follow up based on risk assessment and time of discharge.