Newborn Jaundice After Discharge: Checks and Follow-Up

What does the evidence say about newborn jaundice after discharge?

1. AAP recommends bilirubin measurement before discharge and using that result to guide the timing of follow-up and repeat testing. The clinician receiving the baby after discharge should have the relevant result and risk information. Ask for the actual appointment or testing plan. 1
2. A bilirubin number must be interpreted with the baby's age, how quickly the level is changing, and whether the baby was born early. Looking at the yellow color alone cannot determine whether more testing or phototherapy is needed. 2
3. Suboptimal intake can contribute to jaundice during the first week. Most jaundiced newborns can continue breastfeeding. If additional milk is needed, the plan is individualized and can include expressed maternal milk, pasteurized donor milk, or formula. 3
4. Feeding frequency and effectiveness, swallowing, diaper output, and weight trend help assess milk intake. Get help promptly for difficulty feeding or inadequate output. A baby who repeatedly falls asleep without feeding effectively may need more than reassurance about frequent attempts. 4
5. A newborn fever of 100.4°F (38°C) or higher rectally requires immediate medical evaluation. Fever, severe lethargy, or difficulty breathing should not wait for the next bilirubin check. Use emergency services for a baby who cannot be awakened or is struggling to breathe. 5

What belongs in the jaundice follow-up plan?

• Before discharge, obtain the bilirubin result and the specific follow-up instructions.
• At home, watch feeding, diapers, alertness, and any increase in yellow color.
• After phototherapy or another assessment, confirm the next check and return precautions.

Questions to discuss with your care team