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Treatment of unconjugated hyperbilirubinemia in term and late preterm infants

Ronald J Wong, BA
Vinod K Bhutani, MD, FAAP
Section Editor
Steven A Abrams, MD
Deputy Editor
Melanie S Kim, MD


Almost all newborn infants develop neonatal hyperbilirubinemia (jaundice) with total serum or plasma bilirubin (TB) levels that exceed 1 mg/dL (17.1 micromol/L) the upper limit of normal for adults. Neonates with severe hyperbilirubinemia (defined as a TB >25 mg/dL [428 micromol/L]) are at risk for bilirubin-induced neurologic dysfunction (BIND) including kernicterus, which occurs when bilirubin crosses the blood-brain barrier and binds to brain tissue (figure 1). (See "Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants", section on 'Bilirubin-induced neurologic dysfunction (BIND)'.)

The treatment of neonatal unconjugated hyperbilirubinemia and prevention of severe hyperbilirubinemia are reviewed here. The clinical manifestations, evaluation, pathogenesis, and etiology of this disorder are discussed separately. (See "Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants" and "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" and "Pathogenesis and etiology of unconjugated hyperbilirubinemia in the newborn".)


Neonatal hyperbilirubinemia in infants ≥35 weeks gestational age (GA) is defined as total serum or plasma bilirubin (TB) >95th percentile on the hour-specific Bhutani nomogram (figure 2) [1].

Severe neonatal hyperbilirubinemia, or "extreme hyperbilirubinemia," is defined as a TB >25 mg/dL (428 micromol/L). It is associated with an increased risk for bilirubin-induced neurologic dysfunction (BIND), which occurs when bilirubin crosses the blood-brain barrier and binds to brain tissue. (See "Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants", section on 'Bilirubin-induced neurologic dysfunction (BIND)'.)

Acute bilirubin encephalopathy (ABE) is used to describe the acute manifestations of BIND. (See "Clinical manifestations of unconjugated hyperbilirubinemia in term and late preterm infants", section on 'Acute bilirubin encephalopathy'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.
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