AAP updates childhood jaundice and hyperbilirubinemia guidelines for the first time since 2004

For the first time since 2004, the American Academy of Pediatrics (AAP) has updated its guidelines for the management of hyperbilirubinemia, a buildup of bilirubin, a yellowish pigment produced during the normal breakdown of red blood cells and a cause frequent jaundice. in infants. Although similar in many ways to previous recommendations, the new guidelines come after more than eight years of research, which suggests that bilirubin does not cause toxicity unless it reaches levels higher than expected. thought before. Here’s what parents need to know.

Jaundice is extremely common in newborns, but can sometimes be dangerous.

The new guidelinespublished at the beginning of August in the magazine Pediatrics, explain that 80% of newborns will have some degree of jaundice, especially premature babies. Generally speaking, symptoms include yellowing of a baby’s skin and the whites of their eyes, often starting in their face and moving down their body. Some infants may also experience poor feeding and lethargy. But in rare cases, hyperbilirubinemia can lead to kernicterusa type of brain damage that can result from high levels of bilirubin in a baby’s blood, which can lead to athetoid cerebral palsy, hearing and vision loss, and intellectual disability.

Led by Dr. Alex Kemper of Nationwide Children’s Hospital in Columbus, Ohio, the updated guidelines apply to newborns born after 35 weeks of gestational age, which represents the vast majority of newborns and even premature babies in the United States As with previous guidelines, the updated recommendations address issues of prevention, risk assessment, monitoring, and treatment of hyperbilirubinemia.

The new guidelines encourage universal screening for hyperbilirubinemia.

Kemper and his team of neonatologists, hospitalists, primary care pediatricians, nurses and breastfeeding experts recommend that all newborns be tested with a device that measures bilirubin levels. through the skin or by a blood test. Although this has been standard practice in many hospitals, the AAP has made it an officially prescribed universal recommendation.

“Measuring bilirubin levels on all babies is a critical step in knowing which babies need phototherapy or light therapy to lower bilirubin levels, or when a baby needs ‘a follow-up after its release,’ Kemper said in a APA press release.

Infantile jaundice is often detected by a yellowish or orange tint to the baby’s skin and eyes.Courtesy of Jamie Kenney

Transcutaneous bilirubinometry (or testing through the skin) works by directing light into the skin and measuring the intensity of the wavelength of light that is returned. The measurement is usually taken by pressing the tape measure against the baby’s breastbone or forehead for instant results. A blood test is done via a ‘heel draw’ where a doctor or nurse will prick the infant’s heel with a small lancet and draw blood into a vial. (Don’t worry, parents: it can be done with other blood screening tests, so your baby won’t have to be pricked too much.) The guidelines also recommend ongoing visual assessment – at least every 12 hours – after delivery or until discharge.

The thresholds for phototherapy and exchange transfusion in the treatment of jaundice have been raised.

Perhaps the most notable revision to the AAP guidelines relates to phototherapy (that is, putting a baby under blue LED lights to decrease bilirubin levels) and blood transfusion. New guidelines have raised the threshold for treatment of hyperbilirubinemia, as the latest research suggests that bilirubin does not cause toxicity unless it reaches higher levels than previously thought. In other words, fewer babies will have to hang around under lights or require a blood transfusion. In addition to modifying the threshold for these treatments, the AAP also offers guidance on when bilirubin should be remeasured, allowing clinicians to better assess the type of follow-up required.

New guidelines, like previous guidelines, emphasize prevention.

Of course, as they say, an ounce of prevention is better than cure, and so to more closely assess and monitor infants who may be at higher risk – such as babies of lower gestational age; babies with a family history of jaundice; genetic ancestry; G6PD deficiency; and Down syndrome; among other factors.

“It is important that hospitals and clinicians caring for newborns have plans in place to prevent serious complications from hyperbilirubinemia,” Kemper said in the AAP statement. “The guideline provides clinicians, birthing centers and hospitals with strategies to prevent worst-case scenarios and to help educate families so they recognize the signs of jaundice and know when to follow up with their pediatrician.”

Comments are closed.