Learning & Implementing Guidelines for Hyperbilirubinemia Treatment (LIGHT)

Neonatal hyperbilirubinemia is one of the most common conditions of the newborn that may necessitate treatment with phototherapy. In August 2022, AAP updated its clinical practice guideline for the management of neonatal hyperbilirubinemia.  

Notable changes and recommendations include raising the threshold to start phototherapy treatment, different treatment thresholds by gestational age, emphasis on evaluating for hemolysis (including obtaining a direct antiglobulin test in infants born to mothers with O blood type who require phototherapy), waiting at least 12-24 hours before obtaining a follow-up bilirubin level after phototherapy for infants at low risk for rebound hyperbilirubinemia, and an emphasis on breastfeeding and enteral feeding over intravenous fluids (IV) unless the infant meets criteria for escalation of care. As providers implement the new guidelines, it will be important to avoid both overtreatment and the rare need for escalation of care to an exchange transfusion.