Emergency Department Clinical Pathway for Evaluation/Treatment
of Neonates with Hyperbilirubinemia/Jaundice

  • Risk Factors
    • Isoimmune Hemolytic Disease
    • G6PD deficiency
    • Asphyxia
    • Significant lethargy
    • Temperature instability
    • Sepsis
    • Acidosis
  • AAP Subcommittee on Hyperbilirubinemia

Triage (Critical/Acute)

Use ED Hyperbili/Jaundice in Neonate Pathway
Nursing Standing Orders
History and Physical
Gestational Age
Determine Age in Hours
Are ANY of the following present:
  • TSB within 2 mg/dL of exchange threshold
  • Less than 35 weeks gestation
  • Ill appearing
  • Neurologic dysfunction
  • Evidence of hemolysis
  • Pathologic Jaundice
YES
TSB above Phototherapy Threshold
YES
NO
Assure Adequate PO Intake
Discharge to Home
Follow-up with PMD

Admit to General Pediatrics
Add neoBlue Light AND neoBlue Blanket
Encourage PO: Consider NG/OG
Consider IV
Place IV: Obtain Additional Labs
IV fluids if Clinically Dehydrated

Contact N/IICU Medical Command
Add neoBlue Light AND neoBlue Blanket
Place IV: Obtain Additional Labs
IV fluids if Ill-Appearing
Posted: October 2009
Revised: May 2022
Authors: D. Aronson, MD, J. Lavelle, MD, C. Jacobstein, MD, N. Boorstein, RN