When can bilirubin (blood test for jaundice) checks be stopped in a newborn?

From the Guidelines

Bilirubin checks in a newborn can be stopped when the total serum bilirubin (TSB) level has declined by 2 to 4 mg/dL below the hour-specific threshold at the initiation of phototherapy, and it has been at least 24 hours since phototherapy was stopped, as indicated by the most recent guidelines 1. When considering stopping bilirubin checks, several factors must be taken into account, including the infant's gestational age, presence of risk factors for hyperbilirubinemia, and the rate of decline of TSB levels after phototherapy.

• For infants who received phototherapy less than 48 hours of age, with a gestational age less than 38 weeks, with a positive direct antiglobulin test (DAT), or suspected of having hemolytic disease, a follow-up TSB measure is recommended 8 to 12 hours after phototherapy discontinuation and on the following day 1.
• All other infants who received phototherapy should have a follow-up TSB within 1 to 2 days after phototherapy discontinuation, with the need for additional TSB testing depending on the post-phototherapy TSB level and trajectory 1. The decision to stop bilirubin monitoring should be individualized, considering the TSB level at which phototherapy was initiated, the cause of the hyperbilirubinemia, the difference between the TSB level and the phototherapy threshold, and the risk of rebound hyperbilirubinemia, as outlined in the latest technical report on phototherapy to prevent severe neonatal hyperbilirubinemia 1. Key considerations include:
• The TSB trajectory, including the rate of rise or decline, to identify possible hemolysis or the effectiveness of phototherapy 1.
• The infant's clinical picture, including feeding patterns, weight gain, and overall health status, to ensure that stopping bilirubin checks does not pose a risk to the infant's health. By following these guidelines and considering the individual infant's needs, healthcare providers can make informed decisions about when to stop bilirubin checks, balancing the need for monitoring with the potential risks and discomforts associated with prolonged testing 1.

From the Research

Bilirubin Checks in Newborns

• Bilirubin checks are an essential part of monitoring newborns for jaundice, which can lead to serious health complications if left untreated 2, 3, 4, 5.
• The American Academy of Pediatrics (AAP) recommends universal neonatal hyperbilirubinemia screening in newborns 35 weeks' gestational age or greater 2.
• However, the AAP also notes that universal screening can lead to unnecessary phototherapy use without sufficient evidence that it decreases the incidence of kernicterus 2.

When to Stop Bilirubin Checks

• Bilirubin checks can be stopped when the newborn is no longer at risk for jaundice, which is typically around 7-10 days of age 3, 4, 5.
• However, some newborns may require longer monitoring, such as those with hemolytic diseases or premature infants 2, 4.
• The decision to stop bilirubin checks should be based on the individual newborn's risk factors and medical history 2, 3, 4, 5.

Factors to Consider

• Gestational age: Newborns born at 35-37 weeks' gestation may require longer monitoring than full-term infants 4.
• Hemolytic diseases: Newborns with hemolytic diseases, such as G6PD deficiency, may require longer monitoring and more aggressive treatment 4, 5.
• Family history: A family history of jaundice or hemolytic diseases may increase the risk of jaundice in the newborn 4.
• Breastfeeding: Breastfeeding can affect bilirubin levels, and mothers who are breastfeeding may need to be monitored more closely 2, 3, 4, 5.