Hyperbilirubinemia in the Neonate Clinical Pathway

Pathway Background and Objectives

Neonatal jaundice is a common diagnosis in pediatrics. In 2004 the AAP released guidelines for care of infants >/= 35 weeks gestation with hyperbilirubinemia in order to avoid severe hyperbilirubinemia and bilirubin encephalopathy. This Clinical Practice Guideline was updated in 2022.

This pathway aims to:

Decrease variation in the care of neonates admitted for hyperbilirubinemia
Triage admission processes including when to directly admit to medical/surgical floors vs. Neonatal Intensive Care Unit
Standardize breastfeeding support during admission, including pumping, when to supplement, and lactation consultation for all breastfeeding infants
Encourage continuation of exclusive breastfeeding
Decrease unnecessary use of intravenous therapies
Guide care involving phototherapy, and decrease delay in initiation of phototherapy
Standardize laboratory monitoring and decrease unnecessary rebound total serum bilirubin testing
Ensure Vitamin D supplementation when indicated

Algorithm Educational Module

Quality Metrics

Percentage of patients with order set usage
Percentage of patients with lactating mother with breastfeeding education completed (electric breast pump provided to mother with instructions and schedule, patient handout on Breastfeeding and Jaundice provided)
Percentage of patients with lactation consult completed in < 24 hours
Percentage of patients with phototherapy start time documented
Average time from arrival to initiation of phototherapy (minutes)
Percentage of patients with phototherapy intensity > 30 µW/cm2/nm
Percentage of infants with continuation of breastfeeding 1 week post hospital discharge
Percentage of infants with continuation of breastfeeding 1 month post hospital discharge
Percentage of families unable to be reached at 1 week
Percentage of families unable to be reached at 1 month
Average length of stay (days)

Key References

Kemper, A. R., et al. (2022). Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics, 150(3), e2022058859.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia (2004). Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics, 114(1), 297–316.
Flaherman VJ, Maisels MJ, and the Academy of Breastfeeding Medicine. ABM Clinical Protocol # 22: Guidelines for Management of Jaundice in the Breastfeeding Infant 35 weeks or More of Gestation – Revised 2017. Breastfeeding Medicine. 2017;12(5): 250-57.
Kellams, A, Harrel, C, Omage, et al, and the Acadmey of Breastfeeding Medicine. ABM Clinical Protocol # 3: Supplementary Feedings in Healthy Term Breastfed Neonate, Revised 2017. Breastfeeding Medicine. 2017;12(3): 1-11.
Maisels JM, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the Newborn Infant 35 Weeks or More Gestation: An Update with Clarifications. Pediatrics. 2009 October;124(4):1193-98.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.