Clinical Pathway for Evaluation/Treatment of Neonates with Hyperbilirubinemia/Jaundice
  • Neurotoxicity Risk Factors for Phototherapy Nomograms
  • Isoimmune Hemolytic Disease
  • G-6-PD Deficiency
  • Asphyxia
  • Significant Lethargy
  • Temperature Instability
  • Sepsis
  • Acidosis
  • AAP Subcommittee on Hyperbilirubinemia
  • Definition of Pathologic Jaundice
  • Present in first 24 hours of life
  • TSB level > age-specific 95%
  • TSB rising > 0.2 mg/dL/hr
  • Conjugated bili (BC) > 1.5 mg/dL or > 20% TSB

Outpatient Management

  • Feeding Recommendations
  • Rechecking Bili Levels
  • Additional Lab Work to Consider
Referral Considerations:

Inpatient Evaluation & Management

Repeat TSB 4 Hours after ED Level
TSB Rising
Consult NICU
If rate of rise
> 0.5 mg/dL/hr
OR
Within 2 mg/dL of exchange threshold
Repeat every 4 hours
until falling
TSB Level Falling
Repeat every 12 hours or with morning labs
Criteria for Discontinuing Phototherapy
Low/medium risk TSB 13-14 mg/dL
High risk TSB 12 mg/dL
Rebound Testing
  • Routine check is NOT recommended
  • Check if:
    • Patient has hemolytic disease (know DAT + and retic count > 7%)
    • OR
    • Phototherapy stopped before 3 days of life
  • TSB below phototherapy threshold
  • Tolerating PO, feeding issues resolved
  • Parental concerns addressed
  • Follow-up plan in place
Posted: September 2016
Revised: March 2017, March 2019 (Reviewed)
Authors: L. Utidjian MD; B. Rezet MD; P. Capucilli, MD; C. Macaulay RN; M. Mai MD; M. Posencheg MD; R. Persky, MD; E. Pete Devon MD