II. Precautions
- Transcutaneous Bilirubin (TcB) measurement correlates well with total Serum Bilirubin (TSB) at lower levels (regardless of ethnicity)
- However, obtain TSB, when TcB >15 mg/dl (256.6 umol/L) or within 3 mg/dl (51.3 umol/L) of a Phototherapy threshold
- References
III. Interpretation: Normal Total Bilirubin in Newborns
-
General
- Normal Increase <5 mg/dl/day (<0.5 mg/dl/hour)
- Conjugated Bilirubin (Direct) fraction <2 mg/dl
- Term Infant
- Peaks: 12.9 at 3 to 4 days of life
- Resolves at 4 to 7 days of life
-
Preterm Infant
- Peaks: 15.0 at 5 to 7 days
- Resolves at 10 to 14 days of life
- Exagerated Physiologic Jaundice
- Peaks 17.0 at age 6 to 8 days of life
- Early-Onset Breast Milk Jaundice
- Same course as exaggerated physiologic Jaundice
- Total Bilirubin peaks < 17 mg/dl by day 4 of life
- Late-Onset Breast Milk Jaundice
- Bilirubin peaks between day of life 6 to 14 of life
- Total Bilirubin often 12 to 20 mg/dl
- Hyperbilirubinemia may persist 2-3 months
IV. Indications: AAP 2022 - Phototherapy in LOW risk TERM infants (>36 weeks and >2 kg, or >35 weeks and >2.5 kg)
- Background
- Use BiliTool or PediTools calculators for exact indication thresholds (thresholds here are rough estimates summarizing guidelines)
- Thresholds updated in AAP 2022 are considerably higher than prior thresholds for initiating Phototherapy
- The upper range reflects the indication for exchange transfusion (Escalate care to NICU when within 2 mg/dl of upper threshold)
-
Gestational age 40 weeks - Thresholds
- Age 24 hours: >=13.0 mg/dl to 21.5 mg/dl
- Age 48 hours: >=17.0 mg/dl to 24.0 mg/dl
- Age 72 hours: >=19.5 mg/dl to 26.0 mg/dl
- Age 96 hours: >=21.5 mg/dl to 27.0 mg/dl
-
Gestational age 38 weeks - Thresholds
- Age 24 hours: >=12.0 mg/dl to 21.5 mg/dl
- Age 48 hours: >=16.0 mg/dl to 24.0 mg/dl
- Age 72 hours: >=18.5 mg/dl to 26.0 mg/dl
- Age 96 hours: >=20.5 mg/dl to 27.0 mg/dl
-
Gestational age 36 weeks - Thresholds
- Age 24 hours: >=11.0 mg/dl to 21.0 mg/dl
- Age 48 hours: >=14.5 mg/dl to 22.0 mg/dl
- Age 72 hours: >=17.5 mg/dl to 24.0 mg/dl
- Age 96 hours: >=19.5 mg/dl to 25.5 mg/dl
- References
V. Indications: AAP 2022 - Phototherapy in HIGH risk TERM infants (>36 weeks and >2 kg, or >35 weeks and >2.5 kg)
- Background
- Use BiliTool or PediTools calculators for exact indication thresholds (thresholds here are rough estimates summarizing guidelines)
- Thresholds updated in AAP 2022 are considerably higher than prior thresholds for initiating Phototherapy
- High risk factors for neurotoxicity include Hemolysis (e.g. g6PD, Hemolytic Disease of the Newborn), Sepsis, instability, albumin <3 g/dl
- The upper range reflects the indication for exchange transfusion (Escalate care to NICU when within 2 mg/dl of upper threshold)
-
Gestational age 38 to 40 weeks - Thresholds
- Age 24 hours: >=10.5 mg/dl to 17.5 mg/dl
- Age 48 hours: >=14.0 mg/dl to 20.0 mg/dl
- Age 72 hours: >=16.5 mg/dl to 22.0 mg/dl
- Age 96 hours: >=18.0 mg/dl to 23.5 mg/dl
-
Gestational age 36 weeks - Thresholds
- Age 24 hours: >=9.5 mg/dl to 16.5 mg/dl
- Age 48 hours: >=12.5 mg/dl to 19.0 mg/dl
- Age 72 hours: >=15.5 mg/dl to 21.0 mg/dl
- Age 96 hours: >=17.0 mg/dl to 22.0 mg/dl
- References