AAP 2022 Hyperbilirubinemia Management Guidelines

Calculator and clinical decision support for the AAP 2022 guidelines for the management of hyperbilirubinemia in newborns 35 or more weeks of gestation.



GA at birth40 completed weeks
Postnatal age24 hours
Bilirubin12 mg/dL
Phototherapy thresholdExchange threshold
No neurotoxicity risk factors
13.3 mg/dL21.4 mg/dL
Confirmatory TSBMeasure TSB if TcB is ≥15 mg/dL or within 3 mg/dL of the phototherapy threshold
Phototherapy1.3 mg/dL below phototherapy threshold
Escalation of care7.4 mg/dL below escalation threshold
Exchange transfusion9.4 mg/dL below exchange threshold
Recommendations

Below phototherapy threshold

Birth hospitalization discharge follow-up recommendations for infants who have NOT received phototherapy

For bilirubin 12 mg/dL at 24 hours age (1.3 mg/dL below the phototherapy initiation threshold):

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


Thresholds for Phototherapy, Escalation of Care, and Exchange Transfusion

Post-birth hospitalization discharge follow-up for infants who have NOT received phototherapy

Phototherapy threshold minus bilirubin measurementDischarge recommendations
0.1 - 1.9 mg/dLAge <24 hoursDelay discharge, consider phototherapy, measure TSB in 4 to 8 hours
Age ≥24 hoursMeasure 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)TSB or TcB in 4 to 24 hours
3.5 - 5.4 mg/dL(regardless of age)TSB or TcB in 1– 2 days
5.5 - 6.9 mg/dLDischarging <72 hoursFollow-up within 2 days; TcB or TSB according to clinical judgment
Discharging ≥72 hoursClinical judgment
≥7.0 mg/dLDischarging <72 hoursFollow-up within 3 days; TcB or TSB according to clinical judgment
Discharging ≥72 hoursClinical judgment

(Complete discharge follow-up table may be helpful to provide comparative context)


Age and Bilirubin
Gestation at birth
Age (hours)
Bilirubin (mg/dL)
Neurotoxicity risks
(required)
No risk factors
ANY risk factors
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Script by Joseph Chou, 2023-08-15

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The User acknowledges and agrees that this tool will be used only as a reference aid, and that the information contained in the product is not intended to be (nor should it be used as) a substitute for the exercise of professional judgement.

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Neurotoxicity Risk Factors

Based on