From the Guidelines
Bilirubin screening is not necessary after 2-3 weeks of age in healthy term newborns. By this time, physiologic jaundice has usually resolved, and the risk of developing significant hyperbilirubinemia decreases substantially 1. Most hospitals and pediatricians follow protocols that include checking bilirubin levels before discharge (usually between 24-72 hours of life) and potentially at the first follow-up visit if clinically indicated.
Key Considerations
- After the neonatal period (first 28 days), bilirubin is generally only checked if there are specific clinical concerns such as persistent or recurrent jaundice, which might indicate an underlying condition requiring investigation.
- The reason for this approach is that physiologic jaundice is a normal process in newborns due to their immature liver function and increased red blood cell turnover.
- As the liver matures and becomes more efficient at conjugating and excreting bilirubin, levels naturally decrease, making routine screening unnecessary beyond the early neonatal period in healthy infants 1.
Clinical Guidelines
- A TcB and/or TSB measurement should be performed on every infant who is jaundiced in the first 24 hours after birth, with the need for and timing of a repeat TcB or TSB measurement depending on the zone in which the TSB falls, the age of the infant, and the evolution of the hyperbilirubinemia 1.
- All bilirubin levels should be interpreted according to the infant’s age in hours, as recommended by the management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation guidelines 1.
From the Research
Bilirubin Screening in Newborns
- The provided studies do not specify an exact age at which bilirubin screening is no longer necessary in newborns 2, 3, 4, 5, 6.
- However, the studies suggest that bilirubin screening is crucial in the first few days of life, particularly in the first 24-48 hours 3, 6.
- One study recommends routine birth hospitalization bilirubin screening and suggests screening no later than 24 hours after birth may be beneficial 3.
- Another study found that early-term newborns have a statistically significant increased risk of jaundice requiring treatment compared to term newborns, and recommends close monitoring of these newborns for pathologic jaundice 6.
- The studies do not provide a specific age at which bilirubin screening can be discontinued, but rather emphasize the importance of ongoing monitoring and screening in the first few days of life to identify newborns at risk of significant hyperbilirubinemia 2, 3, 4, 5, 6.