Back to Basics: Bili Checks

  • The goal is to decrease the risk of developing neurodevelopmental deficits and kernicterus.
  • While there are many causes, the most common pathologic etiologies are hemolysis and Gilbert’s syndrome.
  • Newborns show visible jaundice at serum bilirubin concentrations above 5mg/dL.
  • Severe hyperbilirubinemia: levels greater than 25-30mg/dL.
  • Timing is critical. It is necessary to know the exact time of birth.
  • Infants discharged on day one or two of life are higher risk for readmission.
  • When you get an elevated value or a value that has not decreased since discharge, things to consider include hemolytic anemia, sepsis, liver function testing or an upper GI obstruction.
  • If the total serum bilirubin is at the level for which treatment is recommended (see chart below) or if greater than 25 at any time, the infant should be admitted or transferred to a pediatric hospital for intensive phototherapy.
  • Send type and screen as exchange transfusion may be required for toxic levels Consultation with neonatology and pediatric hematology.



Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2004. 114(1).

Fleisher, G; Ludwig, S. Textbook of Pediatric Emergency Medicine. Baltimore: William and Wilkins. 391-397.