Perspectives

Know Your Guidelines Series: Key Recommendations for the Hospitalist from the 2022 AAP Clinical Practice Guideline on the Management of Hyperbilirubinemia

Authors: Amanda V. Hardy, MD, Chloe N. Hundman, MD, Anna Q. Allen, MD, Christopher D. Jackson, MD, Desirée C. Burroughs-Ray, MD, MPH

Abstract

Jaundice, a clinical condition that results from elevated levels of bilirubin, manifests as yellow discoloration of the skin and mucous membranes. Jaundice occurs in >80% of newborns and is most often physiologic.1 In cases of severe hyperbilirubinemia, newborns are at risk of kernicterus, a devastating and permanent neurological condition that is characterized by decreased alertness, poor feeding, and hypotonia in the first days of life. Risk factors for severe hyperbilirubinemia include, but are not limited to, lower gestational age, hemolysis from any cause, family history, and poor intake in the setting of exclusive breastfeeding. The 2022 American Academy of Pediatrics (AAP) Clinical Practice Guideline Revision provides 25 key action statements for the management of hyperbilirubinemia in newborn infants who are at least 35 weeks’ gestation.2 From these key action statements, we present seven consolidated recommendations that are most pertinent for the pediatric hospitalist.

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References

1. Bhutani VK, Stark AR, Lazzeroni LC, et al; Initial Clinical Testing Evaluation and Risk Assessment for Universal Screening for Hyperbilirubinemia Study Group. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr 2013;162:477-482.e1.
 
2. Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2022;150:e2022058859.
 
3. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 1999;103:6-14.
 
4. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004;114:297-316.