Hyperbilirubinemia/Jaundice — Follow-up, Infants Discharged from Birth Hospital that Have Not Received Phototherapy — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Determining Follow-up for Infants Discharged from the Birth Hospital that
Have Not Received Phototherapy

Start
TcB or TSB measure in infant ≥ 12 hours old
  • Determine hour-specific phototherapy threshold based on gestational age and presence of a known hyperbilirubinemia neurotoxicity risk factor
  • Measure TSB if TcB exceeds 3.0 mg/dL below the phototherapy treatment threshold or if the TcB is ≥ 15 mg/dL
TSB at or above the phototherapy threshold
TSB below the phototherapy threshold
Begin phototherapy
Phototherapy Threshold Minus TcB or TSB Discharge Recommendations
0.1-1.9 mg/dL Age < 24 hours Delay discharge, consider phototherapy, measure TSB in 4 to 8 hours
Age ≥ 24 hours
  • Measure TSB in 4 to 24 hours
  • Options:
    • Delay discharge and consider phototherapy
    • Discharge with home phototherapy if all considerations in the guideline are met
    • Discharge without phototherapy but with close follow-up
2.0-3.4 mg/dL Regardless of age or discharge time TSB or TcB in 4 to 24 hours
3.5-5.4 mg/dL Regardless of age or discharge time TSB or TcB in 1-2 days
5.5-6.9 mg/dL Discharging < 72 hours of life Follow-up within 2 days: TcB or TSB according to clinical judgment
Discharging ≥ 72 hours of life Clinical judgment
≥ 7.0 mg/dL Discharging < 72 hours of life Follow-up within 3 days: TcB or TSB according to clinical judgment
Discharging ≥ 72 hours of life Clinical judgment