Universal screening and prompt follow-up essential to reducing debilitating jaundice among newborns

OTTAWA ― All newborns should be screened for jaundice and closely monitored after hospital discharge to avoid the rare but life-long consequences when this common condition becomes severe, the Canadian Paediatric Society says.  

A CPS statement, Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants (35 or more weeks’ gestation), published in this month’s issue of the CPS peer-reviewed journal Paediatrics & Child Health, offers new Canadian guidelines on recognizing and treating hyperbilirubinemia.  

“Jaundice does not peak until newborns are three to five days old, at which time the majority of them have already been discharged from hospital,” said Dr. Keith Barrington, principal author of the statement and chair of the CPS Fetus and Newborn Committee.  

“Jaundice can be hard to detect ― especially at the time babies go home from hospital. But the severity of jaundice can be predicted through screening, which is now being recommended for all newborns in Canada,” said Dr. Barrington, a neonatologist at the Royal Victoria Hospital in Montreal.  

In rare cases, hyperbilirubinemia (an increase in the blood level of bilirubin, which is the yellow substance causing jaundice) can lead to kernicterus, a life-threatening condition affecting the brain and causing long-term neurological damage such as hearing loss. Jaundice is a common and usually harmless condition that affects 60% of newborns. Some need treatment to stop the jaundice getting too severe. Two per cent go on to develop more severe jaundice, often due to ineffective monitoring. A very small number of the most extremely jaundiced babies can develop kernicterus.  

To reduce the occurrence of hyperbilirubinemia, the statement recommends that bilirubin concentrations be measured in all infants between 24 hours and 72 hours of life. If a mother and her new baby go home before 24 hours, they need an early follow-up visit to a health professional or a home visit by someone who can administer a bilirubin test, as well as look after any other potential health problems.  

The CPS also recommends that at the time of hospital discharge, a copy of the health record including the bilirubin result is given to the family and follow-up arrangements are made for those infants identified by the screening as having a higher chance of becoming severely jaundiced so that they can be examined and have a repeat test if needed.  

CPS recommendations:

• Universal screening for jaundice among newborns should be implemented in Canada.
• Adequate follow-up should be ensured for all infants who are jaundiced.  
• A program for breastfeeding support should be instituted in every facility where babies are delivered.  

To access the full statement, visit Guidelines for detection, management and prevention of hyperbilirubinemia in term and late preterm newborn infants.

About the Canadian Paediatric Society

The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,300 paediatricians, paediatric subspecialists and other child health professionals across Canada.