Choosing Wisely:

Don’t initiate phototherapy in term or late preterm well-appearing infants with neonatal hyperbilirubinemia if their bilirubin is below levels at which the AAP guidelines recommend treatment.

Rationale and Comments: The risk of poor neurologic outcomes, such as cerebral palsy due to kernicterus, is extremely low for term and late preterm newborns with modestly elevated bilirubin levels. Confirmed cases of kernicterus have average bilirubin levels near 40 mg/dL, and are typically associated with hemolysis. While phototherapy for bilirubin values above published thresholds may be useful to prevent severe hyperbilirubinemia and exchange transfusions, its use for bilirubin values below published thresholds is unnecessary and is associated with additional costs and unnecessary hospitalization.
Sponsoring Organizations:
  • Pediatric Hospital Medicine – SHM, AAP, APA
  • Sources:
  • American Academy of Pediatrics guidelines
  • Disciplines:
  • Neonatology
  • References: • American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004 Oct;114(4):1138]. Pediatrics. 2004;114(1):297-316.
    • Wu YW, et al. Risk for cerebral palsy in infants with total serum bilirubin levels at or above the exchange transfusion threshold: a population-based study. JAMA Pediatr. 2015;169(3):239-246.
    • Newman TB, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. NEJM. 2006;354(18):1889-1900.
    • Newman TB, et al. Numbers needed to treat with phototherapy according to American Academy of Pediatrics guidelines. Pediatrics. 2009;123(5):1352-1359.
    • Kuzniewicz MW, et al. Incidence, etiology, and outcomes of hazardous hyperbilirubinemia in newborns. Pediatrics. 2014;134(3):504-509.
    • Kuzniewicz MW, et al. Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use. Pediatrics. 2009;124(4):1031-1039.
    • Wickremasinghe AC, et al. Neonatal phototherapy and infantile cancer. Pediatrics. 2016;137(6):e20151353.

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