Hyperbilirubinemia/Jaundice — Summary of Changes in AAP 2022 Guidance — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Summary of Changes in AAP 2022 Guidance

AAP, 2022 Clinical Practice Guidelines Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation  

  1. Prevention and early identification of infants at risk for hyperbilirubinemia who may require treatment are again emphasized:
    • All infants require TSB
      • Visual assessment for jaundice every 12 hrs after delivery
      • TcB 24-48 hrs after birth
    • Continued risk factors clarification:
    • Raised thresholds for Phototherapy Initiation and Exchange Transfusion delineated by gestational age
    • Infant can be treated as DAT negative if:
      • Mother was RhD antibody negative prior to receiving RhIG during pregnancy
      • And, infant is DAT positive to anti-RhD only
  2. Updated Bilitool™  
  3. New guidance on phototherapy discontinuation thresholds. Consider discontinuing if TSB decreased by at least 2 mg/dL below the hour-specific threshold at the initiation of phototherapy:
    • E.g., not the current age phototherapy threshold when repeat TSB drawn
  4. Transcutaneous bilirubin (TcB) is a reliable screening test and has a good correlation with TSB:
  5. New guidance on measuring rebound TSB following discontinuation of phototherapy:
  6. New guidance on home biliblanket usage:
  7. Clarification of breastfeeding-associated jaundice:
    • Suboptimal Intake Hyperbilirubinemia
      • Formerly known as breastfeeding jaundice attributed to suboptimal intake, peaks at 3-5 days “suboptimal intake hyperbilirubinemia”
    • Breast Milk Jaundice Syndrome
      • Prolonged elevated unconjugated hyperbilirubinemia that persists with adequate milk intake that can last up to 3 months
  8. Caution should be used if applying this guidance in countries with more limited healthcare resources