Hyperbilirubinemia/Jaundice — Exchange Transfusion Thresholds — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Exchange Transfusion Thresholds

Summary of Changes AAP 2022 Guidance

Hyperbilirubinemia Neurotoxicity Risk Factors

  • Isoimmune hemolytic disease
  • Other hemolytic diseases
    • e.g., G6PD Deficiency
  • Significant clinical instability in the previous 24 hrs
    • e.g., sepsis, acidosis, asphyxia, significant lethargy, temperature instability
  • Albumin < 3.0 g/dL

Exchange Transfusion Thresholds:
No Hyperbilirubinemia Neurotoxicity Risk Factors Other than Gestational Age

The dashed lines for the first 24 hrs indicate uncertainty due to a wide range of clinical circumstances and a range of responses to phototherapy

Line graph, no risk factors for infants with gestational age 35-38+ weeks: Total serum bilirubin (mg/dl) rises steeply from approximately 15-18 mg/dl to approximately 25-27mg/dl, from day 0 to day 4, then slightly rises or stabilizes from day 4 to day 14.

Exchange Transfusion Thresholds:
One or More Hyperbilirubinemia Neurotoxicity Risk Factors Other than Gestational Age

The dashed lines for the first 24 hrs indicate uncertainty due to a wide range of clinical circumstances and a range of responses to phototherapy.

Line graph, one or more risk factors for infants with gestational age of 35-38+ weeks: Total serum bilirubin (mg/dl) rises steeply from approximately 13-15 mg/dl to approximately 21-24 mg/dl, from day 0 to day 4, then slightly rises or stabilizes from day 4 to day 14.

Note

Thresholds are based on expert opinion rather that strong evidence on when phototherapy benefit exceeds its potential harm.

Reference

AAP, 2022 Clinical Practice Guidelines Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More weeks of Gestation