Screening

Prenatal screening of the maternal blood group and antibodies (e.g., for Rh disease) is recommended.[43]​ Screening asymptomatic neonates is important for early recognition of jaundice and signs of bilirubin encephalopathy in order to evaluate the etiology, 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 the 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.[7]​​[13][44]​​​​[45]​​​​​​

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.​​​​​​[7]​ Combining a predischarge 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 predischarge TSB/TcB, gestational age, and other risk factors for hyperbilirubinemia is therefore suggested.[7]​ 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 (≥0.3 mg/dL per hour in the first 24 hours or ≥0.2 mg/dL per hour thereafter) suggests hemolysis with a higher risk of subsequent hyperbilirubinemia, and further investigation and follow-up are indicated.[7]​​

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