Screening

Antenatal screening of the maternal blood group and antibodies (e.g., for Rh disease) is recommended.[45]​ Screening asymptomatic neonates is important for early recognition of jaundice and signs of bilirubin encephalopathy in order to evaluate the aetiology, closely monitor the serum bilirubin levels and provide therapeutic intervention, if necessary. Because jaundice occurs mostly in the first week of life, this is the best time to screen. Following birth and prior to discharge from hospital, the newborn should be visually assessed for jaundice at least every 12 hours. Visual assessment of jaundice alone is considered unreliable and screening of transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) is usually recommended.[9]​​[15][46]​​​​[47]​​​​​​

The American Academy of Pediatrics recommends that either the TcB or TSB should be measured between 24 and 48 hours after birth or before discharge if that occurs earlier.[9]​​​​​ Combining a pre-discharge measurement of TSB or TcB with clinical risk factors is thought to improve the accuracy of risk prediction. A structured approach to management and follow-up according to the pre-discharge TSB/TcB, gestational age, and other risk factors for hyperbilirubinaemia is therefore suggested.[9]​ When there are two or more successive TSB or TcB measurements, it is helpful to plot them on the nomogram to assess the rate of bilirubin elevation. A rapid rate of increase (≥5 micromol/L [≥0.3 mg/dL] per hour in the first 24 hours or ≥3 micromol/L [≥0.2 mg/dL] per hour thereafter) suggests haemolysis with a higher risk of subsequent hyperbilirubinaemia, and further investigation and follow-up are indicated.[9]​​

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