Hyperbilirubinemia/Jaundice — Rebound Bilirubin — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Rebound Bilirubin: Monitoring TSB After Phototherapy

General

Discontinue phototherapy when TSB is within 2 mg/dL of the phototherapy threshold used to initiate phototherapy.

Measure TSB after phototherapy based on the risk of rebound hyperbilirubinemia.

There is the option to measure TcB instead of TSB if phototherapy has stopped for more than 24 hours.

Phototherapy During Birth Hospitalization

  • With any of the following:
    • Phototherapy before 48 hrs of age
    • DAT +
    • Known/suspected hemolytic disease
  • Measure TSB 6-12 hrs after PTx discontinued
  • Repeat TSB on the following day
With NONE of the above Measure TSB the day after PTx discontinued

Re-admission for Phototherapy After Birth Hospitalization Discharge

Did receive phototherapy during birth hospitalization Measure TSB the day after PTx discontinued
Did NOT receive phototherapy during the birth hospitalization
  • Measure TSB 1-2 days after PTx discontinued
  • or
  • Clinical follow-up to determine if TSB needed
  • Risk factors to consider:
    • TSB at the time phototherapy was discontinued
    • Gestational age < 38 weeks
    • Feeding, weight gain

Home Phototherapy After Birth Hospitalization Discharge

Did NOT receive phototherapy during the birth hospitalization
  • Measure TSB 1-2 days after phototherapy discontinued
  • or
  • Clinical follow-up to determine if TSB needed
  • Risk factors to consider:
    • TSB at the time phototherapy was discontinued
    • Gestational age < 38 weeks
    • Feeding, weight gain

Reference

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