Neonatal Jaundice: IAP Guidelines
Neonatal jaundice is common, occurring in 60% in term and 80% in preterm infants.Appears after 24 hours of life, decreases after 5–6 days, and undetectable after 14 days. Maximum values seldom exceed 15 mg/dL.The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for Neonatal Jaundice. The lead author for these guidelines Neonatal Jaundice is...
Neonatal jaundice is common, occurring in 60% in term and 80% in preterm infants.
The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for Neonatal Jaundice. The lead author for these guidelines Neonatal Jaundice is Dr. Naveen Jain along with co-author Dr. Ravi Sachan and Dr. Praveen Vaenkatagiri. The guidelines come Under the Auspices of the IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan.
Following are the major recommendations of guidelines:
Severe Jaundice— Hyperbilirubinemia:
Any jaundice visible in first 24 hours of life
Yellow staining of palms and soles or deep yellow appearance (measure bilirubin values using transcutaneous bilirubinometer or laboratory testing of serum sample, when in doubt)
Bilirubin values >95 centile for gestation/weight/age in hours, evaluated on standard charts like the American Academy of Pediatrics (AAP) or National Institute for health and Care Excellence (NICE), UK) charts
Warning signs of encephalopathy such as poor feeding and lethargy
Evaluation for Risk of Hyperbilirubinemia:
Before discharge 24-72 hrs from birth All babies must be evaluated clinically for bilirubin levels while in hospital and before discharge; and confirmed objectively when in doubt, by a transcutaneous bilirubinometer or serum bilirubin plotted on hour specific nomograms. Kramer's Criteria is helpful in clinical assessment of the severity of the jaundice. The clinical assessment requires natural light (can be faulty in hospital lighting). It also depends on experience of personnel and subjectivity of assessment)
Use the hour-specific nomogram to evaluate risk before discharge from birth admission. Babies with values in high-risk zone must be re-evaluated within 24 hours
After discharge (until day 5–6 of life) from hospital
• All babies reviewed within 48 hours and babies with higher risk within 24 hours of discharge for yellow staining of palms and soles or deep yellow appearance (measure values using transcutaneous Bilirubinometer or laboratory testing of serum sample, when in doubt, use specific charts such as AAP or NICE charts to evaluate need for treatment).
• Look for lactation problems (excess weight loss and delayed transition of stool to yellow color), infrequent stool, and urine.
• Exclude early signs of encephalopathy (poor feeding and lethargy)
Close follow-up (within 24 hours of discharge) is warranted in risk groups
BOX 1: Risk groups: Need close attention.
þ Gestation of baby <38 completed weeks
þ Lactation not established
þ Predischarge bilirubin in high-risk zone (transcutaneous bilirubin >13 mg/dL)
þ Glucose-6-phosphate dehydrogenase (G6PD) deficiency
- American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297-316.
- Bhutani V, Gourley GR, Adler S, Kreamer B, Dalman C, Johnson LH. Noninvasive measurement of total serum bilirubin in a multiracial predischarge newborn population to assess the risk of severe hyperbilirubinemia. Pediatrics. 2000;106(2):E17.
- Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR, Kazmierczak S, et al. Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy. J Pediatr. 2013;162(3):477-82.
- Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani VK. A comparison of alternative riskassessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008;121(1):e170-9.
- Ministry of Health and Family Welfare. Facility Based Newborn Care (FBNC) Training: Operational Guidelines. Government of India: Ministry of Health and Family Welfare; 2014.
- Newman TB, Liljestrand P, Jeremy RJ, Ferriero DM, Wu YW, Hudes ES, et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med. 2006;354(18):1889-900.
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
I have done my Bachelor of pharmacy from United Institute of Pharmacy and currently pursuing pharmaceutical MBA from Jamia hamdard. I worked as an intern at the position of content creator in Medical Dialogue and am highly obliged to the company for giving me this wonderful opportunity.