Hyperbilirubinemia

Clinical Pathways promote evidence-based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by a methodical review of available evidence and consensus among committee members.

Clinical Pathway:

• Hyperbilirubinemia Algorithm
• Hyperbilirubinemia Synopsis (provides care standards employed for this clinical pathway)

Additional tools associated with this Clinical Pathway:

• Available via Children’s Mercy electronic medical records for depart instructions:
  • Search for jaundice or hyperbilirubinemia to find ‘Hyperbilirubinemia, Indirect, Age < 3 months’
• Available via the Children’s Mercy public website and can be accessed by internal and external providers as well as caregivers:
  • https://kidshealth.org/ChildrensMercy/en/
  • Direct parents or caregivers to this website, and there they will find a search area to look up information on jaundice

Inclusion and exclusion criteria:

Inclusion Criteria - Screening

• All newborns ≥ 35 weeks gestational age.
• Early screening will be completed on those newborns ≥ 35 weeks gestational age that meet the following criteria:
  • Positive direct antiglobulin test (DAT will be obtained automatically when the mother has type O blood or is Rh negative)
  • Newborn has an onset of visible jaundice within the first 24 hours after birth
  • The newborn has a first-degree relative with a heritable hemolytic disease (i.e., G6PD deficiency or hereditary spherocytosis)

Exclusion Criteria - Screening

• Newborn known to have direct hyperbilirubinemia
• Newborn is < 35 weeks gestation
• Newborn has received home phototherapy

Inclusion Criteria - Phototherapy

• Newborns ≥ 35 weeks gestational age having a total serum bilirubin (TSB is the total of both direct and indirect serum bilirubin levels) within 3 mg/dL of or exceeding the phototherapy threshold and/or have associated risk factors
  • Neurotoxicity risk factors include – gestational age < 38 weeks (risk increases with the degree of prematurity), albumin < 3.0 g/dL, isoimmune hemolytic disease, sepsis, significant clinical instability in the previous 24 hours, or Rh incompatibility
• Newborns ≥ 35 weeks gestational age having a total serum bilirubin < 2mg/dL below the phototherapy threshold and demonstrate clinical risk factors for progressive hyperbilirubinemia
  • Progressive hyperbilirubinemia risk factors include – early onset of jaundice (within the first 24 hours after birth), rapidly rising bilirubin levels, significant bruising or cephalohematoma, or Rh incompatibility

Exclusion Criteria - Phototherapy

• Newborn TSB levels are ≥ 3mg/dL below the phototherapy threshold and show no signs of any associated risk factors or acute bilirubin encephalopathy
• Newborn has received home phototherapy

Inclusion Criteria - Escalation of Care

• Newborn ≥ 35 weeks gestational age having any of the following:
  • Signs of acute bilirubin encephalopathy (ABE)
  • Rapidly rising TSB levels
  • TSB levels within 2 mg/dL below the exchange transfusion threshold

Exclusion Criteria - Escalation of Care

• Newborn has direct hyperbilirubinemia
• Newborn is < 35 weeks gestation
• Newborn receiving home phototherapy

Hyperbilirubinemia Clinical Pathway Committee Members and Representation

• Kristie Marble, DO, FAAP | Hospital Medicine | Committee Chair
• Giang Nguyen, MD, FAAP | Hospital Medicine | Committee Member
• Deborah Holland, MD | Hospital Medicine | Committee Member
• Dena Hubbard, MD, FAAP | ICN| Committee Member
• Sian Best, MD | Hospital Medicine | Committee Member
• Megan Collins, MD, MPH | Hospital Medicine | Committee Member

EBP Committee Members:

• Kathleen Berg, MD, FAAP | Hospitalist, Evidence Based Practice
• Andrea Melanson, OTD, OTR/L | Evidence Based Practice

Publication dates:

• Finalized date: 08/2023
• Next expected revision date: August 2026

If you have any questions regarding this content or identify a broken link, please email evidencebasedpractice@cmh.edu.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.