II. Resources
III. Interpretation: Risk of Hyperbilirubinemia in term infants (>36 weeks and >2 kg, or >35 weeks and >2.5 kg)
- See Severe Neonatal Hyperbilirubinemia Risk Factor
- See Exchange Transfusion in Newborns
- See Phototherapy
-
Phototherapy is indicated when a threshold is crossed based on an infants Hyperbilirubinemia risk factors
- High Risk Infant
- Gestational age >35 weeks AND <38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor
- Intermediate Risk Infant
- Gestational age >38 weeks AND Severe Neonatal Hyperbilirubinemia Risk Factor OR
- Gestational age >35 weeks AND <38 weeks AND No Risk Factors
- Low Risk Infant
- Gestational age >38 weeks AND No Risk Factors
- High Risk Infant
- Age 12 hours of life
- High risk Infant: Serum Bilirubin >3.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >5 mg/dl
- Low risk Infant: Serum Bilirubin >7.1 mg/dl
- Minimal risk transcutaneous Bilirubin <4 mg/dl
- Age 24 hours of life
- High risk Infant: Serum Bilirubin >4.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >6 mg/dl
- Low risk Infant: Serum Bilirubin >7.7 mg/dl
- Minimal risk transcutaneous Bilirubin <5.5 mg/dl
- Age 36 hours of life
- High risk Infant: Serum Bilirubin >7 mg/dl
- Intermediate risk Infant: Serum Bilirubin >9 mg/dl
- Low risk Infant: Serum Bilirubin >11 mg/dl
- Minimal risk transcutaneous Bilirubin <8 mg/dl
- Age 48 hours of life
- High risk Infant: Serum Bilirubin >8.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >10.8 mg/dl
- Low risk Infant: Serum Bilirubin >13.1 mg/dl
- Minimal risk transcutaneous Bilirubin <9 mg/dl
- Age 60 hours of life
- High risk Infant: Serum Bilirubin >9.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >12.7 mg/dl
- Low risk Infant: Serum Bilirubin >15.2 mg/dl
- Minimal risk transcutaneous Bilirubin <10 mg/dl
- Age 72 hours of life
- High risk Infant: Serum Bilirubin >11.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >13.4 mg/dl
- Low risk Infant: Serum Bilirubin >16 mg/dl
- Minimal risk transcutaneous Bilirubin <12.5 mg/dl
- Age 84 hours of life
- High risk Infant: Serum Bilirubin >11.6 mg/dl
- Intermediate risk Infant: Serum Bilirubin >14.7 mg/dl
- Low risk Infant: Serum Bilirubin >16.7 mg/dl
- Age 96 hours of life
- High risk Infant: Serum Bilirubin >12.4 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.2 mg/dl
- Low risk Infant: Serum Bilirubin >17.4 mg/dl
- Age 108 hours of life
- High risk Infant: Serum Bilirubin >12.9 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.5 mg/dl
- Low risk Infant: Serum Bilirubin >17.6 mg/dl
- Age 120 hours of life
- High risk Infant: Serum Bilirubin >13.3 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.8 mg/dl
- Low risk Infant: Serum Bilirubin >17.7 mg/dl
- Age 132 hours of life
- High risk Infant: Serum Bilirubin >13.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.6 mg/dl
- Low risk Infant: Serum Bilirubin >17.5 mg/dl
- Age 144 hours of life
- High risk Infant: Serum Bilirubin >13.2 mg/dl
- Intermediate risk Infant: Serum Bilirubin >15.3 mg/dl
- Low risk Infant: Serum Bilirubin >17.3 mg/dl
IV. 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
