Managing the jaundiced newborn: a persistent challenge.

©2015 8872147 Canada Inc. or its licensors CMAJ, March 17, 2015, 187(5) 335 Pediatricians and family physicians deal regularly with jaundiced newborn infants who emerge unscathed from their transient exposure to an elevated serum bilirubin level. Yet, despite published guidelines for the management of neonatal jaundice, there are rare infants in whom bilirubin encephalopathy develops. Canada currently reports the highest incidence in the developed world of 1 in 67 000 to 1 in 44 000 live births.1 In this review, I present an approach to managing the jaundiced newborn that is based on published guidelines.2–5 The aim is to help clinicians identify and manage jaundice in the newborn, intervene when appropriate and, when possible, prevent bilirubin-induced brain damage. It would be ideal if the published guidelines for the management of hyperbilirubinemia, including treatment with phototherapy and exchange transfusion, were based on estimates of when the bene fit of these interventions exceeded their risks and costs. These estimates should come from randomized trials or high-quality, systematic observational studies, but such studies are rare. Guidelines must therefore rely on relatively uncertain estimates of risk and benefits, often from conflicting results. In addition, use of a single peak bilirubin level to predict longterm behavioural and developmental outcomes is not reliable and will often lead to conflicting results. Because of the lack of evidence, current guidelines are mainly based on consensus, as are the recommendations included in this article. Herein, I discuss the management of infants of 35 or more weeks of gestation, cared for in wellbaby nurseries, and do not address hyperbilirubinemia in more premature infants. A complete discussion of the approach to the preterm infant can be found in a recent publication.6 A summary of the evidence used in this review appears in Box 1.