Major risk factors for severe hyperbilirubinemia
Total Serum Bilirubin (TSB) or Transcutaneous Bilirubin (TcB) in the high risk
zone (see Figure 1)
Jaundice in the first 24 hours
ABO incompatibility or other hemolytic disease (eg, G6PD deficiency)
Gestational Age 35-36 weeks
Phototherapy in a previous sibling
Cephalohematoma or other significant bruising
Exclusive Breastfeeding, and if not nursing well and weight loss >10%
East Asian race
AAP recommendations on evaluation of the healthy term infant with jaundice
Maternal blood type and indirect Coombs test
Cord blood type and direct Coombs (DAT-AHG) test
If maternal type and Coombs not known or if mother is Rh negative
Consider possibility of hemolytic disease and G6PD deficiency
TSB level if infant is jaundiced within the first 24 hours of life
Physical exam of infant
NOTE: If the total serum bilirubin is at a level at which exchange transfusion is
recommended (see figure 3) OR if the level is 25mg/dL or higher, THIS IS
CONSIDERED A MEDICAL EMERGENCY AND THE INFANT SHOULD
IMMEDIATELY BE ADMITTED.