Remarks

• The postnatal age for universal TcB screening at discharge should be guided by the timing of health facility discharge. The Guideline Development Group (GDG) considered that all healthy newborns should receive facility care for at least 24 hours after birth. The GDG considered that transcutaneous bilirubin screening at discharge should be followed up with serum bilirubin measurement, appropriate treatment, and follow-up as indicated by age-appropriate nomograms.40
• The GDG emphasized that the existing WHO recommendations on routine assessment of the newborn for danger signs, including jaundice and yellow palms and soles, still apply (See Recommendation 25 in this guideline). During health facility stay, clinicians should ensure that all newborns are routinely monitored for the development of jaundice and that serum bilirubin should be measured in those at risk; that is, in all babies if jaundice appears on day 1, and in all babies if palms and soles are yellow at any age (148).
• The GDG decided not to formulate a recommendation on universal screening for neonatal hyperbilirubinaemia using TSB due to the lack of evidence comparing universal TSB with universal TcB measurement. There was uncertainty around the benefits of universal TSB screening compared with clinical screening for important clinical outcomes. Additionally, the GDG considered that the costs were large, and feasibility and acceptability varied markedly.