Hyperbilirubinemia/Jaundice — Phototherapy Thresholds — Clinical Pathway: All Settings

Neonates with Hyperbilirubinemia/Jaundice Clinical Pathway

Phototherapy Thresholds

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

Phototherapy 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 35-40+ weeks: Total serum bilirubin (mg/dl) rises steeply from approximately 6-9 mg/dl to approximately 18-22 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 than strong evidence on when phototherapy's benefit exceeds its potential harm.

TSB near or above the phototherapy threshold in the 1st 24 hours of life is likely associated with hemolytic disease.

Phototherapy Thresholds:
One or More Neurotoxicity Risk Factors Present 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 5-6 mg/dl to approximately 16-18 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 than strong evidence on when phototherapy's 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