T-bilirubin > 95th percentile for age in hours, 看起來黃
2/3 newborns 第一週看起來黃，10% of term, 25% of preterm 要照光
大部份是生理性(出不敷入), 因 bilirubin conjugating 不好；丟不出去；做太多(溶血或頭血腫)
Major risk factors for developing severe hyperbilirubinemia include predischarge bilirubin in the high-risk zone, jaundice observed in the first 24 hours, isoimmune or other hemolytic disease, a previous sibling requiring phototherapy, cephalohematoma or significant bruising, East Asian race, and excessive weight loss in a breastfed infant.
病理性： hemolysis, enzyme deficiencies, or liver and biliary abnormalities.
Total serum bilirubin levels > 25-30 mg/dL (428-513 mcmol/L) in term infants (lower levels in premature infants) are associated with the highest risk of kernicterus, or permanent sequela from bilirubin accumulation in the brain, 就他媽的積在基底核造成以後身體協調有問題之類的
Test cord blood for direct (Coombs) antibody test and blood type if the mother is Rh-negative (Strong recommendation). Consider testing if no prenatal blood grouping was done or if the mother is O+ (Weak recommendation). 他媽的測血型+Rh就對
見黃非黃，見不黃則非嚴重不黃(我在打三洨)
三洨Minolta：For assessment of jaundice a transcutaneous bilirubin (TcB) is used to plot the level on an hour-specific nomogram to estimate the risk of subsequent bilirubin level > the 95th percentile for age.
Consider TcB in any infant clinically jaundiced in the first 24 hours after birth, if degree of jaundice appears excessive for infant's age, or if there is any doubt about the degree of clinical jaundice (Weak recommendation).
Consider TcB for screening in all infants before discharge.
Recommended by the American Academy of Pediatrics and Canadian Paediatric Society.
The United States Preventive Services Task Force found insufficient evidence to make a recommendation about screening for hyperbilirubinemia.
啥時要抽T-Bil？ if the infant is < 24 hours old, < 35 weeks gestation, receiving phototherapy, or has a TcB > 14.6 mg/dL (250 mcmol/L).
Proceed with further investigation if the cause is not evident after a thorough history and examination, if there is a history of significant hyperbilirubinemia in siblings, in any infant receiving phototherapy, when the total serum bilirubin crosses percentiles on the nomogram, or there is an elevated conjugated (direct) bilirubin.
Consider using the bilirubin/albumin (B/A) ratio in conjunction with serum bilirubin level and other clinical factors to determine the need for exchange transfusion and in infants > 35 weeks gestation (Weak recommendation).
Check total and conjugated bilirubin in neonates who appear ill or who have jaundice for > 2-3 weeks to identify neonatal cholestasis.
Breastfed infants should be fed 8-12 times/day to help prevent hyperbilirubinemia from dehydration.
Consider supplementation with expressed breast milk or formula if the infant has weight loss > 10% of birth weight, poor urine output, poor caloric intake, or delayed stooling.
Use a nomogram or calculator to determine the serum bilirubin level at which phototherapy should be initiated.
Consider using the American Academy of Pediatrics (AAP) phototherapy nomogram for infants > 35 weeks gestational age (or see DynaMed calculator for Newborn Hyperbilirubinemia Assessment, which will also provide AAP recommendation for phototherapy based on age, gestational age, and presence of neurotoxicity risk factors to determine when to initiate phototherapy) (Weak recommendation).
Consider starting phototherapy in infants < 35 weeks gestational age if levels are above age-specific values:
Use phototherapy with a light source emitting in the 460-490 nm wavelength range when indicated.
Infants should have their eyes protected and be closely monitored for temperature and hydration status.
Consider double or triple phototherapy for better results compared to single phototherapy or therapy with a fiberoptic blanket (BiliBlanket).
Consider adjusting the light distance and intensity to lower the serum bilirubin with the aim of lowering the serum bilirubin by 0.5 mg/dL (8.6 mcmol/L) per hour over the first 4-8 hours (if there is no ongoing hemolysis or other pathologic process). Phototherapy may be discontinued when total serum bilirubin (TSB) has decreased by 4-5 mg/dL (68.4-85.5 mcmol/L) or to 13-14 mg/dL (222.4-239.5 mcmol/L) if the child has been readmitted for hyperbilirubinemia.
Consider not checking a rebound level in neonates weighing > 1,800 g without hemolysis or a clinical indication.
For infants approaching the level for exchange transfusion, increase effectiveness of phototherapy by lining the bassinet with foil or a white cloth, removing diapers, and not interrupting therapy for feedings.
Determine the serum bilirubin level at which blood exchange transfusion should be initiated.
Consider using American Academy of Pediatrics exchange transfusion nomogram or Newborn Hyperbilirubinemia Assessment calculator for infants ≥ 35 weeks gestational age at birth (Weak recommendation).
Consider the following indications in infants < 35 weeks gestational age:
Perform in infants showing signs of acute bilirubin encephalopathy (such as hypertonia, arching, retrocollis, opisthotonos, high-pitched cry).
Consider in infants receiving intensive phototherapy to maximal surface area with TSB levels continuing to increase toward the following levels:
Exchange small aliquots of blood with the same quantity of donor red cells until the blood volume has been replaced twice.
Consider pre-exchange albumin infusion to reduce mean bilirubin levels, repeat exchange transfusion rates, and postexchange phototherapy duration.
Medications to consider to reduce the need for phototherapy in resource-poor areas may include clofibrate, tin-mesoporphyrin, and phenobarbitone.