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 birth | 40 completed weeks | |
| Postnatal age | 24 hours | |
| Bilirubin | 12 mg/dL | |
| Phototherapy threshold | Exchange threshold | |
|---|---|---|
| No neurotoxicity risk factors | 13.3 mg/dL | 21.4 mg/dL |
| Confirmatory TSB | Measure TSB if TcB is ≥ 15 mg/dL or within 3 mg/dL of the phototherapy threshold | |
| Phototherapy | 1.3 mg/dL below phototherapy threshold | |
| Escalation of care | 7.4 mg/dL below escalation threshold | |
| Exchange transfusion | 9.4 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:
| |
Bilirubin 12 mg/dL at 24 hours age (40 weeks gestation with no neurotoxicity risk factors)
• if measurement was a TcB, obtain a confirmatory TSB
• phototherapy not needed: result is 1.3 mg/dL below phototherapy initiation threshold of 13.3 mg/dL
• if no prior phototherapy and plan to discharge, measure TSB in 4 to 24 hours. Consider starting phototherapy.
| Phototherapy threshold minus bilirubin measurement | 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:
| |
| 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/dL | Discharging <72 hours | Follow-up within 2 days; TcB or TSB according to clinical judgment |
| Discharging ≥72 hours | Clinical judgment | |
| ≥7.0 mg/dL | Discharging <72 hours | Follow-up within 3 days; TcB or TSB according to clinical judgment |
| Discharging ≥72 hours | Clinical judgment | |
| Optional age calculator | |
| Date of birth | |
| Date of measurement | |
Script by Joseph Chou, 2025-10-16
DISCLAIMER
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.
In view of the possibility of human error or changes in medical science, the User should confirm the information in the product through independent sources. This product is provided without warranties of any kind, express or implied, and the author disclaims any liability, loss, or damage caused by it or its content.
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Neurotoxicity Risk Factors
Based on