cpt code for phototherapy of newborn

For most newborns, hematomas from the birth process resolve spontaneously. 96.4. 2002;65(4):599-606. Cincinnati Childrens, umbilical hernia: www.cincinnatichildrens.org/health/u/umbilical-herni, Copyright 2023, AAPC Consistent with available guidelines, continued phototherapy is not medically necessary for healthy term infants when the following criteria for discontinuation of phototherapy are met: A delay in discharge from the hospital in order to observe the infant for rebound once the bilirubin has decreased is not considered medically necessary. phototherapy in the home, applied by a . Aggressive phototherapy, as compared with conservative phototherapy, significantly reduced the mean peak serum bilirubin level (7.0 versus 9.8 mg/dL [120 versus 168 micromol/L], p < 0.01) but not the rate of the primary outcome (52 % versus 55 %; relative risk, 0.94; 95 % confidence interval [CI]: 0.87 to 1.02; p = 0.15). BiliCheck variability (+/- 2 SD of the mean bias from serum bilirubin) was within -87.2 to 63.3 micromol/L, while BiliMed variability was within -97.5 to 121.4 micromol/L. The authors concluded that the use of antenatal phenobarbital to reduce neonatal jaundice in red cell isoimmunized pregnant women has not been evaluated in randomized controlled trials. There are implications for future healthcare needs (e.g., having a specialty consult ordered prior to discharge). Clinical Policy: Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150 Coding Implications . Honar et al (2016) found that ursodiol added at the time of phototherapy initiation showed a significant reduction in peak bilirubin levels and duration of phototherapy in term infants with unconjugated hyperbilirubinemia without any adverse effects. They stated that there is a need for larger trials to determine how effective clofibrate is in reducing the need for, and duration of, phototherapy in term and preterm infants with hyperbilirubinemia. Initial hospital or birthing center care, per day, for E/M of normal newborn infant, Initial care per day, for E/M of normal newborn infant seen in other than hospital or birthing center, Initial hospital or birthing center care, per day, for E/M of normal newborn infant admitted and discharged on the same date, Circumsion, using clamp or other device with regional dorsal penile or ring block, Circumsion, as above, without dorsal penile or ring block, Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate (28 days of age or less), Circumsion, surgical excision, other than clamp, device, or dorsal slit, neonate, old then 28 days of age. Furthermore, an UpToDate review on "Evaluation of unconjugated hyperbilirubinemia in term and late preterm infants" (Wong and Bhutani, 2017) states that "TcB measurements are not reliable in infants undergoing phototherapy. These investigatorscalculated the sensitivity and specificity of early TSB, TcB measurements, or risk scores in detecting hyperbilirubinemia. 2019;8:CD012731. No statistical difference in the prevalence of UGTA1A1 gene variants was found between cases and controls (p = 1). Santa Barbara, CA: Elsevier Saunders; 2011. San Carlos, CA: Natus Medical Inc.; 2002. Clin Pediatr (Phila). When no additional resources are used, this is not coded on the inpatient record, and is part of the pediatricians well-baby check. 4th ed. Pediatrics. Cochrane Database Syst Rev. Kernicterus in full-term infants--United States, 1994-1998. J Matern Fetal Neonatal Med. Nagar and associates (2016) noted that TcB devices are commonly used for screening of hyperbilirubinemia in term and near-term infants not exposed to phototherapy. eMedicine J. These investigators also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-randomized trials. Oral zinc for the prevention of hyperbilirubinaemia in neonates. This is caused by a small opening in the abdominal muscles that abdominal contents (e.g., fluid, abdominal lining) spill through. The fetal blood is designed to attract oxygen from the mothers blood. Thayyil S, Milligan DW. Arch Dis Child Fetal Neonatal Ed. Family physicians who perform newborn circumcision should separately report this service. Hyperbilirubinemia in the term infant: When to worry, when to treat. All but 1 of the included studies were conducted in Iran. UGT1A1 is the rate-limiting enzyme in bilirubin's metabolism. Wong RJ, Bhutani VK. They included English-language publications evaluating the effects of screening for bilirubin encephalopathy using early TSB, TcB measurements, or risk scores. The China National Knowledge Infrastructure and MEDLINE databases were searched. A total of 150 term Caucasian neonates, 255 measurements of TSB and TcB concentration were obtained 2 hours after discontinuing phototherapy. Subgroup analysis was done for AB0 incompatible cases. This is not the same as for professional services coding, where the first-listed diagnosis is the reason for the encounter. Do not subtract direct (conjugated) bilirubin. Data were statistically extracted and evaluated using RevMan 5.3 software. Savinetti-Rose B, Kempfer-Kline RE, Mabry CM. Utilization Mangement and Q uality Review Manual Nebraska M edicaid, 2014, Phototherapy equipment (471 N AC 18-004.45A) For well infants 35 - 37 6/7 wk, can adjust TSB levels for intervention around the medium risk line. Stevenson DK, Fanaroff AA, Maisels MJ, et al. @media print { Usually, procedures coded: Low-cost, low-risk screening and prevention procedures usually are not coded. However, they stated that due to limitations of the trials, current evidence is in sufficient regarding the use of massage therapy for the management of NNH in routine practice. Aetna considers management of physiologic hyperbilirubinemia medically necessary in preterm infants (defined as an infant born prior to 37 weeks gestation) according to guidelines published by the AAP. Some watchful waiting issues require continued outpatient evaluation until resolution. Phototherapy was started at an average of 7 h of age, and the first IVIG dose was administered at an average of 13 h of life; nearly 25% received a second IVIG dose. But unless the breech presentation or other malpresentation caused a significant finding for the newborn, do not code it on the inpatient hospital record. Our providers amend their office note to indicate the patient was admitted due to results then charge an Initial Outpatient Care code (99218-99220) for the day of admission and then 99217 for discharge. The authors concluded that the findings of this study demonstrated that the 388 G>A mutation of the SLCO1B1 gene is a risk factor for developing neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations; the SLCO1B1 521 T>C mutation provides protection for neonatal hyperbilirubinemia in Chinese neonates, but not in white, Thai, Brazilian, or Malaysian populations. There was no evidence of a significant difference in duration of phototherapy between the prebiotic and control groups, which was only reported by 1 study (MD 0.10 days, 95 % CI: -2.00 to 2.20; 1 study, 50 infants; low-quality evidence). The main outcomes of the trials were analyzed by Review Manager 5.3 software. When the pediatrician spends additional time explaining the skin condition, and the findings affect the episode of care, it should be coded on professional encounters. A total of 15 studies (2 including preterm neonates and 13 including term neonates) were included in this review. This reduction may be offset by an increase in mortality among infants weighing 501 to 750 g at birth. Use total bilirubin. These researchers examined whether the UGT1A1*28 allele is associated with extreme hyperbilirubinemia. An example is hemangiomas (e.g., strawberry hemangiomas), which do not impinge on vital structures and are not located in the periorbital area, lip, neck, or sacral region. Otherwise healthy newborn infants with hyperbilirubinemia without signs of hemolytic disease; gestational age 33 weeks; birth weight . For the term neonates, there were significantly lower bilirubin levels in the clofibrate group compared to the control group after both 24 and 48 hours of treatment with a weighted mean difference of -2.14 mg/dL (95 % CI: -2.53 mg/dL to -1.75 mg/dL) (-37 mol/L; 95 % CI: -43 mol/L to -30 mol/L] and -1.82 mg/dL (95 % CI: -2.25 mg/dL to -1.38 mg/dL) (-31 mol/L; 95 % CI: -38 mol/L to -24 mol/L), respectively. In utero, the fetus requires larger amounts of hemoglobin for oxygenation. } Associations between G6PD, OATP1B1 and BLVRA variants and susceptibility to neonatal hyperbilirubinaemia in a Chinese Han population. Am Fam Physician. Rates of death in the aggressive-phototherapy and conservative-phototherapy groups were 24 % and 23 %, respectively (relative risk, 1.05; 95 % CI: 0.90 to 1.22). Normal Newborn visit, day 2 3. www.hkjpaed.org/pdf/2007%3B12%3B93-95.pdf sacral dimple Description This policy details medical necessity criteria for home phototherapy for the treatment of neonatal . Accessed January 30, 2019 . The authors stated that this study had several drawbacks. 6. Murki S, Dutta S, Narang A, et al. Understanding why a pediatrician documents a finding enables you to determine if it should be coded. J Fam Pract. After the newborn begins to breath on his own, the fetal blood is destroyed and replaced with blood that works with lungs. The dose of zinc varied from 5 to 20mg/day and duration from 5 to 7 days. Deshmukh J, Deshmukh M, Patole S. Probiotics for the management of neonatal hyperbilirubinemia: A systematic review of randomized controlled trials. E0202 is the HCPC for phototherapy that would normally be billed by the hospital/dme provider. 2. 92558 Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. They performed a systematic review of RCTs of probiotic supplementation for prevention or treatment of jaundice in neonates (any gestation or weight) using the Cochrane methodology. Analysis was performed on an intention-to-treat basis. For a better experience, please enable JavaScript in your browser before proceeding. Swelling in such a hydrocele is uniform, over time, until the fluid is absorbed by the body. Chu L, Xue X, Qiao J. Efficacy of intermittent phototherapy versus continuous phototherapy for treatment of neonatal hyperbilirubinaemia: A systematic review and meta-analysis. Valaes T. Problems with prediction of neonatal hyperbilirubinemia. All 3 review authors independently assessed study eligibility and quality. Probiotics supplementation treatment showed efficacy [RR: 1.19, 95 % CI: 1.12 to 1.26), p < 0.00001] in neonatal jaundice. Transcutaneous bilirubinometry in the context of early postnatal discharge. Usually, clicking hips lead to no findings but are noted so other providers know there is not issue. 1998;101(1 Pt 1):25-31. Armanian and colleagues (2019) stated that hyperbilirubinemia occurs in approximately 2/3 of all newborns during the first days of life and is frequently treated with phototherapy. Paediatrics Child Health. 2016;36(10):858-861. There is no CPT code because these hospital screenings are usually done by hospital staff who are trained by an audiologist. Clin Pediatr (Phila). As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. The literature search was done for various RCTs by searching the Cochrane Library, PubMed, and Embase. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: A systematic review and meta-analysis. The pediatrician will spend time evaluating the condition, and at some point, a code in the Q53 Undescended and ectopic testicle range will be used. The beroptic system consists of a pad of Prebiotics for the prevention of hyperbilirubinaemia in neonates. color: blue 1994;61(5):424-428. Therefore, well-designed, large randomized, double blind, placebo-controlled trials would be needed to further confirm the efficacy of probiotics. } To determine if the administration of the anti-infective (e.g., erythromycin) externally to the eye (3E0CX2 Introduction of oxazolidinones into eye, external approach) is coded, check if your hospital has a policy on inpatient procedure collection. J Perinatol. The drug was administered into the mouth of the infant by the plastic measure provided with the bottle or with a spoon. list-style-type : square !important; A total of 9 RCTs (prophylactic: 6 trials, n=1,761; therapeutic: 3 trials, n=279) with low- to high-risk of bias were included. All of the outcome measures should be monitored by a standardized effective report system in clinical trials and rare serious adverse reaction could be observed through epidemiological studies. The authors concluded that zinc sulfate could not reduce the TSB on 3 days and 7 days, the incidence of hyperbilirubinemia and phototherapy requirement, but resulted in significantly decreased duration of phototherapy. J Pediatr (Rio J). Exploring the genetic architecture of neonatal hyperbilirubinemia. cpt code for phototherapy of newborn. Extreme neonatal hyperbilirubinemia and a specific genotype: A population-based case-control study. With the common genotype as reference, the odds ratio of extreme hyperbilirubinemia was 0.87 (range of 0.68 to 1.13) for UGT1A1*28 heterozygotes and 0.77 (range of 0.46 to 1.27) for homozygotes. No study assessed harms of screening. Clin Pediatr (Phila). A total of 25 infants had been randomized into the DXM group; 29 into the placebo group. Morris BH, Oh W, Tyson JE, et al; NICHD Neonatal Research Network. When the newborn is critically ill or injured, codes exist for reporting of services provided during interfacility transport, initial critical care, and subsequent critical services. These researchers stated that additional large, well-designed RCTs are needed in neonates that compare effects of enteral supplementation with prebiotics on neonatal hyperbilirubinemia with supplementation of milk with any other placebo (particularly distilled water) or no supplementation. A total of 259 neonates were included in the meta-analysis. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. The influence of zinc sulfate on neonatal jaundice: A systematic review and meta-analysis. padding: 10px; You must log in or register to reply here. Pediatrics. For inpatient hospital coding, a condition is clinically significant if it requires: Note: These perinatal guidelines are the same as the general coding guidelines for additional diagnoses, except for the final point regarding implications for future healthcare needs. The increased bilirubin from hemolysis often needs phototherapy, exchange transfusion or both after birth. Copyright Aetna Inc. All rights reserved. Sacral dimples without diagnostic services, such as diagnostic imaging, are not coded on inpatient records. Some watchful waiting conditions include: Some conditions happen more frequently in premature newborns such as cryptorchidism and umbilical hernias. They used a fixed-effect method in combining the effects of studies that were sufficiently similar; and then used the GRADE approach to assess the quality of the evidence. One study reported a significant reduction in the risk of hyperbilirubinemia and rate of treatment with phototherapy associated with enteral supplementation with prebiotics (RR 0.75, 95 % CI: 0.58 to 0.97; 1 study, 50 infants; low-quality evidence). Seidman DS, Stevenson DK, Ergaz Z, et al. Okwundu CI, Okoromah CA, Shah PS. Aetna considers prebiotics / probiotics experimental and investigational for the treatment ofneonatal hyperbilirubinemia becausetheir effectiveness for this indication has not been established. 2013;162(3):477-482. The lining of the abdomen pouches into the scrotum to surround the testicle. The smallest but significant difference between TSB and TcB was found on the lower abdomen. Accessed July 16, 2002. OL LI { The rate of neurodevelopmental impairment alone was significantly reduced with aggressive phototherapy. #closethis { 7. Stevenson DK, Wong RJ. } Pediatrics. Toward understanding kernicterus: A challenge to improve the management of jaundiced newborns. color: blue!important; Metalloporphyrins in the management of neonatal hyperbilirubinemia. Correlation between neonatal hyperbilirubinemia and vitamin D levels: A meta-analysis. The SLCO1B1 521 T>C mutation showed a low risk of neonatal hyperbilirubinemia in Chinese neonates, while no significant associations were found in Brazilian, white, Asian, Thai, and Malaysian neonates. Once the skin is clear or alm cpt code for phototherapy of newbornhippo attacks human video. /* aetna.com standards styles for templates */ Ip S, Glicken S, Kulig J, et al. Chen and co-workers (2017) stated that probiotics supplementation therapy could assist to improve the recovery of neonatal jaundice, through enhancing immunity mainly by regulating bacterial colonies. Home phototherapy. 2010;15(3):164-168. Only 1 study was able to show reduction in the mean TSB level and requirement of phototherapy with zinc, and the remaining studies did not report any positive effect. Jaundice in healthy term neonates: Do we need new action levels or new approaches? Waltham, MA: UpToDate;reviewed January 2016. A condition does not need to be coded on the inpatient hospital encounter to be coded on the pediatricians hospital encounter. Systematic review of global clinical practice guidelines for neonatal hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Discharge normal newborn day 3 _____ 2. Clayton,VIC: Centre for Clinical Effectiveness (CCE); 2003. Policy Home phototherapy is considered reasonable and necessary for a full-term Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2002. Screening had good ability to detect hyperbilirubinemia: reported area-under-the-curve values ranged between 0.69 and 0.84, and reported sensitivities and specificities suggested similar diagnostic ability. These investigators included trials where neonates with hyperbilirubinemia received either clofibrate in combination with phototherapy or phototherapy alone or placebo in combination with phototherapy. The authors concluded that the UGT1A1*28 allele was not associated with risk for extreme hyperbilirubinemia in this study. Natus Medical Inc. ETCOc - An indicator of elevated hemolysis in neonatal hyperbilirubinemia. This risk increased significantly in the CC genotype carriers at the rs4149056 locus of the SLCO1B1 gene (OR=2.17, 95 % CI: 1.87 to 2.33), whereas it decreased significantly in individuals carrying the G-allele at the rs699512 locus of the BLVRA gene (adjusted OR=0.84, p= 0.01, 95 % CI: 0.75 to 0.95). Code History 2016 (effective 10/1/2015): New code (first year of non-draft ICD-10-PCS) 2017 (effective 10/1/2016): No change The authors concluded that intermittent phototherapy appeared to be as effective as continuous phototherapy for the treatment of neonatal hyperbilirubinemia and was safer than continuous phototherapy. Mean STB levels, mg/dL, at 72 12 hours were comparable in both the groups (n = 286; mean difference (MD) -0.20; 95 % CI: -1.03 to 0.63). Two studies also provided results as Bland-Altman difference plots (mean TcB-TSB differences -29.2 and 30 mol/L, respectively). . You are using an out of date browser. Additionally, no serious adverse reaction was reported. However, the results remain controversial. Procedures included in the services represented by code 99477 include those listed for the Critical Care Services subsection of CPT (codes 99291 and 99292), as well as additional procedures listed in the Inpatient Neonatal and Pediatric Critical Care subsection (codes 99468-99476, 99466-99467). Petersen and colleagues (2014) stated that extreme hyperbilirubinemia (plasma bilirubin greater than or equal to 24.5 mg/dL) is an important risk factor for severe bilirubin encephalopathy. Johnson LH. Phototherapy in the home setting. An alternative to prolonged hospitalization of the full-term, well newborn. Databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Database (Wan Fang), Chinese Biomedical Literature Database (CBM), VIP Database for Chinese Technical Periodicals (VIP) were searched and the deadline was December 2016; RCTs of probiotics supplementation for pathological neonatal jaundice in publications were extracted by 2 reviewers. } Arch Dis Child Fetal Neonatal Ed. These researchers performed a systematic review with meta-analysis including genetic studies, which assessed the association between neonatal hyperbilirubinemia and 388 G>A, 521 T>C, and 463 C>A variants of SLCO1B1 between January of 1980 and December of 2012. Thirteen infants homozygous for (TA)7 polymorphism associated with GS were in the case group (18.6 %) and 14 in the control group (20.0 %). } The authors concluded that genetic variants of bilirubin metabolism genes, including G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512, were associated with the risk of neonatal hyperbilirubinemia, and are potential markers for predicting the disorder. at the end of this policy for important regulatory and legal information. www.hayesinc.com. They stated that further research is needed before the use of TcB devices can be recommended for these settings. 2011;12:CD007969. Yang L, Wu, Wang B, et al. This Clinical Policy Bulletin may be updated and therefore is subject to change. There is insufficient evidence to support the use of metalloporphyrins (e.g., stannsoporfin (tin mesoporphyrin), Stanate, WellSpring Pharmaceutical Corporation, Neptune, NJ) for the treatment of neonatal jaundice. 1992;31(6):345-352. Two hundred years ago, newborns would have been placed on blankets in the sun for newborn jaundice. Inpatient treatment is not generally medically necessary for preterm infants who present with a TSB less than 18 mg/dL, as these infants can usually be treated with expectant observation or home phototherapy. 1992;89:821-822. list-style-type: upper-alpha; Stevenson DK, Fanaroff AA, Maisels MJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Moreover, individuals carrying the A-allele of G6PD 1388 G>A and BLVRA rs699512 had a significantly increased risk of developing neonatal hyperbilirubinemia (OR=5.01, p< 0.001, 95 % CI: 3.42 to 7.85). US Preventive Services Task Force; Agency for Healthcare Research and Quality. J Pediatr. Data were extracted and analyzed independently by 2 review authors (MG and HM). The therapy may be in the form of a lamp, light panel, or special light blanket. For more information about congenital hydrocele, visit: www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview#1. list-style-type: lower-roman; Published March 24, 2016 (updated June 1 2, 2018). However, there was insufficient evidence to recommend their use because of inadequate data on safety and long-term outcomes. With time, the lacrimal ducts mature and the membrane covering the nasolacrimal ducts open. UpToDate[online serial]. Because it is a screening (not diagnostic), the test does not meet the definition of a diagnostic procedure or therapeutic treatment for a clinically significant condition. Treating providers are solely responsible for medical advice and treatment of members. NY State J Med. Front Pharmacol. Evans D. Neonatal jaundice. Moreover, these investigators stated that infants with bilirubin levels greater than 25 mg/dL, those who are not responding to phototherapy, and those with evidence of acute bilirubin encephalopathy should be treated with exchange transfusion, with initiation based on an infants age in hours and neurotoxicity risk factors. These researchers identified studies through Medline searches, perusing reference lists and by consulting with United States Preventive Services Task Force(USPSTF) lead experts. There was no difference in the treatment efficacy and TSB, while there was a significant difference in phototherapy duration and side effects after treatment of intermittent phototherapy and continuous phototherapy for neonatal hyperbilirubinemia. .newText { These ELBW infants had participated in a randomized controlled trial of early DXM therapy thataimed toevaluate effects on chronic lung disease. 2001;21(Suppl 1):S63-S87. Do not code this condition for the newborn inpatient encounter, unless additional resources are used. Nagar G, Vandermeer B, Campbell S, Kumar M. Effect of phototherapy on the reliability of transcutaneous bilirubin devices in term and near-term infants: A systematic review and meta-analysis. Petersen JP, Henriksen TB, Hollegaard MV, et al. The G6PD 1388 G>A, SLCO1B1 rs4149056 and BLVRA rs699512 SNPs had a significant impact on STB levels. If the screening must be done during the well-baby check, possible CPT codes to collect the screening are: Toggle navigation. Normal Newborn visit, initial service 1. Cochrane Database Syst Rev. Aggressive vs. conservative phototherapy for infants with extremely low birth weight. Do not code the condition as part of the newborn hospitalization unless it requires a consult, diagnostic or therapeutic services, prolonged length of stay, increased nursing services, or there is documentation by the provider for future healthcare needs. In preterm infants, phototherapy should be initiated at 50 to 70 % of the maximum indirect levels below: * Complications include but are not limited to prenatal asphyxia, acidosis, hypoxia, hypoalbuminemia, meningitis, intraventricular hemorrhage, hemolysis, hypoglycemia, or signs of kernicterus. The meta-analyses of 2 studies demonstrated a significant reduction in the length of hospital stay (MD -10.57 days, 95 % CI: -17.81 to -3.33; 2 studies, 78 infants; I = 0 %, p = 0.004; low-quality evidence). For instance, abnormal findings on screenings for example, newborn hearing screening or lab screenings are not coded in the inpatient record, unless: Here are several watchful waiting findings to consider. 2017;30(16):1953-1962. They used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 5), Medline via PubMed (1966 to June 14, 2018), Embase (1980 to June 14, 2018), and CINAHL (1982 to June 14, 2018). Report an inclusive screening finding (R94.120 Abnormal auditory function study) in the professional record so the newborn can be retested at the well-baby checks. PICOS eligibility criteria were used to select original studies published from 1984 through 2019. Watchko JF, Lin Z. These researchers used the standard methods of the Cochrane Collaboration and its Neonatal Review Group for data collection and analysis. The efficacy of intravenous fluid supplementation for neonatal hyperbilirubinemia: A meta-analysis of randomized controlled studies. Sometimes, a newborns clavicle is fractured during a vaginal delivery. Wennberg RP, Ahlfors CE, Bhutani VK, et al. Support Lucile Packard Children's Hospital Stanford and child and maternal health, AAP Clinical Practice Guideline -- Full Version, Assessing Risk Based on Bilirubin Level -- "BiliTool", Infants who have not latched-on or nursed effectively for 12 hours, Infants supplemented more than once in 24 hours, Mothers with a history of breastfeeding failure, Antepartum mothers at risk of preterm delivery, AAP Clinical Practice Guideline - Summary.