AAP Clinical Practice Guideline AAP Subcommittee on Hyperbilirubinemia. Pediatrics. 2004;114:297–316 Copyright © 2003, Rev 2005 American Academy of Pediatrics Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation Nomogram for designation of risk in 2840 well newborns at 36 or more weeks’ gestational age with birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values.
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AAP Clinical Practice Guideline
AAP Subcommittee on Hyperbilirubinemia. Pediatrics. 2004;114:297–316
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation
Nomogram for designation of risk in 2840 well newborns at 36 or more weeks’ gestational age with birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth weight of 2500 g or more based on the hour-specific serum bilirubin values.
Jaundice and Breastfeeding Infants <38 weeks’ gestation and
breastfed at higher risk Systematic assessment on all infants
before discharge for the risk of severe hyperbilirubinemia
Provide parents with written and verbal information about newborn jaundice
Provide appropriate follow-up based on the time of discharge and the risk assessment
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Management of Breastfeeding JaundiceIncrease caloric intake.Increase breastfeeding
frequency to 10–12 feedings/day.
Increase duration of breastfeeding.
Improve latch and positioning.
Provide supplements only when medically indicated.
Enhance milk production and transfer.
Decrease enterohepatic reabsorption.
Increase stool output.Lower serum bilirubin.
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Breastmilk Jaundice Definition
Begins after day of life 5–7. Increased bilirubin reabsorption
from intestine. Lasts several weeks to months.
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Breastmilk Jaundice Definition
Begins after day of life 5–7. Increased bilirubin reabsorption
from intestine. Lasts several weeks to months.
Management Avoid interruption of breastfeeding
in healthy term babies. No routine indication for water or
formula supplementation. If bilirubin >20 mg/dL, consider
phototherapy. Rule out other causes of
prolonged jaundice.Copyright © 2003, Rev 2005 American Academy of Pediatrics
Nursing Supplementation
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Illustration by Tony LeTourneau
Milk Expression Wash hands before manual or
hand expression. Use a good-quality electric
pump for regular expression. Milk storage
Chill as soon as possible. Refrigerate milk for up to 2
days. Freeze for longer storage.
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Milk Expression
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Photo © Jane Morton, MD, FAAP
Photo © Kay Hoover, MEd, IBCLC
Return to the Workplace or School Continued breastfeeding is
feasible and desirable for mother and infant.
Prepare ahead by discussing with the employer or school personnel.
Delay introduction of bottles until milk supply well established at 3–4 weeks.
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Employed Mother
Breaks for feeding/expressing
Private, clean place to pump
Refrigerator or cooler with ice packs to store and transport milk
Workplace Support
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Illustration by Tony LeTourneau
Adolescents and Breastfeeding
Highly recommended for adolescent mothers.
Prenatal education and postpartum support are essential.
Arrange with school personnel to express milk at school or use on-site child care program, if available.
Maintain healthy diet with adequate calories, 1,300 mg calcium per day, 15 mg iron, and a daily multivitamin.Copyright © 2003, Rev 2005 American Academy of Pediatrics
Breastfeeding and Maternal Illness Most maternal acute minor
illnesses and infections are compatible with breastfeeding. Breastfed infant receives protective
components from mother’s breastmilk.
Interruption of nursing may predispose an infant to an upper respiratory or gastrointestinal tract infection or may increase the risk of severity if an infection occurs.
Copyright © 2003, Rev 2005 American Academy of Pediatrics
Breastfeeding and Maternal Illness
A few infections are not felt to be routinely compatible with breastfeeding in the US. HIV, HTLV-I, HTLV-II
Some infections require temporary cessation. Lesions on the breast due to active
herpes or syphilis Active, infectious tuberculosis until
treatment is initiated Varicella, if developed 5 days or less
before delivery and within 48 hours after deliveryAAP Committee on Infectious Diseases, 2003
Copyright © 2003, Rev 2005 American Academy of Pediatrics
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