001), and that only 56% of the infants who received phototherapy had a TSB level in the recommended range for phototherapy. A large retrospective study of infants in hospitals that used universal TSB/TcB screening found that their rates of phototherapy were more than twice those of hospitals without universal screening (9.1% vs. 12 Universal screening increases phototherapy rates, possibly inappropriately. 10, 11 Screening will identify infants earlier who require phototherapy, but there is no evidence that phototherapy or exchange transfusion decreases the risk of bilirubin encephalopathy. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence that screening for hyperbilirubinemia is associated with improved clinical outcomes. Encouragement from health care professionals is important to promote breastfeeding in these situations.Īlthough screening can identify infants whose TSB level will likely exceed the 95th percentile, the U.S. However, interrupting breastfeeding for the treatment of jaundice increases the risk of early discontinuation of breastfeeding. Infants who breastfeed exclusively-particularly those who consume inadequate calories-are at increased risk of hyperbilirubinemia. Exchange transfusion leads to complications in about 5% of treated infants and has a mortality rate of three or four per 1,000 infants. If indicated, phototherapy should be initiated based on gestational age and risk factors. Phototherapy is an effective treatment for hyperbilirubinemia, but the number needed to treat varies widely depending on sex, gestational age, and time since delivery. Infants who appear jaundiced should be evaluated by a risk score or by measurement of total serum or transcutaneous bilirubin. Younger gestational age and exclusive breastfeeding are the strongest risk factors for the development of hyperbilirubinemia. Universal screening may also increase rates of phototherapy, sometimes inappropriately. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence that screening improves outcomes. The American Academy of Pediatrics recommends universal screening with bilirubin levels or targeted screening based on risk factors. Universal screening for neonatal hyperbilirubinemia is controversial. Although neonatal jaundice is common, acute bilirubin encephalopathy and kernicterus (i.e., chronic bilirubin encephalopathy) are rare.
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