![]() ![]() The management goals are to exclude pathologic causes of hyperbilirubinemia and initiate treatment to prevent bilirubin neurotoxicity.Ĭharacteristics: increased unconjugated bilirubin level, normal percentage of reticulocytesĬharacteristics: increased unconjugated and conjugated bilirubin level, negative Coombs' test, conjugated bilirubin level of >2 mg per dL (34 μmol per L) or >20% of total serum bilirubin level, conjugated bilirubin in urineīiliary obstruction: biliary atresia, choledochal cyst, primary sclerosing cholangitis, gallstones, neoplasm, Dubin-Johnson syndrome, Rotor's syndrome Jaundice is considered pathologic if it presents within the first 24 hours after birth, the total serum bilirubin level rises by more than 5 mg per dL (86 mol per L) per day or is higher than 17 mg per dL (290 mol per L), or an infant has signs and symptoms suggestive of serious illness. Few term newborns with hyperbilirubinemia have serious underlying pathology. Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. ![]() More recent recommendations support the use of less intensive therapy in healthy term newborns with jaundice. Historically, management guidelines were derived from studies on bilirubin toxicity in infants with hemolytic disease. Hyperbilirubinemia is one of the most common problems encountered in term newborns. ![]()
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