Screening, Prevention and Management of Neonatal Hyperbilirubinemia

Neonatal hyperbilirubinemia affects approximately 60% of term and 80% of preterm neonates in the first week of life. In neonates, unconjugated bilirubin above a threshold level, crosses the blood brain barrier and predisposes the neonate to acute or chronic bilirubin encephalopathy. Clinical recognition and assessment of jaundice can be difficult in neonates, especially in those with darker skin tone. Once jaundice is recognised there is uncertainty about when to treat, how to monitor and there is widespread variation in practices across the world regarding the use of phototherapy, monitoring under phototherapy and exchange transfusion. There is a need for more uniform evidence based and consensus based practice, where evidence is lacking. This guideline attempts to provide evidence based recommendations on screening and management of neonatal jaundice.