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Abstract
Jaundice occurs in most newborn infants. Most jaundice is benign, but because of the
potential toxicity of bilirubin, newborn infants must be monitored to identify those
who might develop severe hyperbilirubinemia and, in rare cases, acute bilirubin encephalopathy
or kernicterus. The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia
and bilirubin encephalopathy while minimizing the risks of unintended harm such as
maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment. Although
kernicterus should almost always be preventable, cases continue to occur. These guidelines
provide a framework for the prevention and management of hyperbilirubinemia in newborn
infants of 35 or more weeks of gestation. In every infant, we recommend that clinicians
1) promote and support successful breastfeeding; 2) perform a systematic assessment
before discharge for the risk of severe hyperbilirubinemia; 3) provide early and focused
follow-up based on the risk assessment; and 4) when indicated, treat newborns with
phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia
and, possibly, bilirubin encephalopathy (kernicterus).