Hyperbilirubinemia: current guidelines and emerging therapies

Pediatr Emerg Care. 2011 Sep;27(9):884-9. doi: 10.1097/PEC.0b013e31822c9b4c.


It is estimated that about two thirds of newborns will appear clinically jaundiced during their first weeks of life. As newborns and their mothers spend fewer days in the hospital after birth, the number of infants readmitted yearly in the United States for neonatal jaundice over the last 10 years has increased by 160%. A portion of these infants present to the emergency department, requiring a careful history and physical examination assessing them for the risk factors associated with pathologic bilirubin levels. Although the spectrum of illness may be great, the overwhelming etiology of neonatal jaundice presenting to an emergency department is physiologic and not due to infection or isoimmunization. Therefore, a little more than a good history, physical examination, and indirect/direct bilirubin levels are needed to evaluate an otherwise well-appearing jaundiced newborn. The American Academy of Pediatrics' 2004 clinical practice guidelines for "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation" are a helpful and easily accessible resource when evaluating jaundiced newborns (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;114/1/297). There are several exciting developments on the horizon for the diagnosis and management of hyperbilirubinemia including increasing use of transcutaneous bilirubin measuring devices and medications such as tin mesoporphyrin and intravenous immunoglobulin that may decrease the need for exchange transfusions.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Bilirubin / analysis
  • Bilirubin / metabolism
  • Bilirubin / radiation effects
  • Blood Group Incompatibility / complications
  • Blood Group Incompatibility / diagnosis
  • Breast Feeding
  • Diagnosis, Differential
  • Emergencies
  • Erythroblastosis, Fetal / diagnosis
  • Exchange Transfusion, Whole Blood
  • Female
  • Hemoglobinopathies / complications
  • Hemoglobinopathies / diagnosis
  • Humans
  • Hyperbilirubinemia, Neonatal* / diagnosis
  • Hyperbilirubinemia, Neonatal* / epidemiology
  • Hyperbilirubinemia, Neonatal* / etiology
  • Hyperbilirubinemia, Neonatal* / physiopathology
  • Hyperbilirubinemia, Neonatal* / therapy
  • Immunoglobulins, Intravenous / therapeutic use
  • Infant, Newborn
  • Jaundice, Neonatal / diagnosis
  • Jaundice, Neonatal / epidemiology
  • Kernicterus / etiology
  • Kernicterus / prevention & control
  • Male
  • Metabolism, Inborn Errors / complications
  • Metabolism, Inborn Errors / diagnosis
  • Metalloporphyrins / therapeutic use
  • Phototherapy
  • Practice Guidelines as Topic
  • Pregnancy
  • Rh Isoimmunization
  • Sepsis / complications
  • Sepsis / diagnosis


  • Immunoglobulins, Intravenous
  • Metalloporphyrins
  • tin mesoporphyrin
  • Bilirubin