Hour-specific Nomogram for Risk Stratification

Infant age48 hours
Total bilirubin12 mg/dl
Risk zone

High Intermediate Risk

Risk zone is one of several risk factors for developing severe hyperbilirubinemia.

Recommended Follow-up

Hyperbili Risk LevelInterval
Lower Risk
(>= 38 weeks and well)
Follow-up within 48 hours and consider TcB/TSB at follow-up
Medium Risk
(>=38 weeks + hyperbili risk factors OR 35 to 37 6/7 weeks and well)
Evaluate for phototherapy and check TcB/TSB within 24 hours
Higher Risk
(35 to 37 6/7 weeks and hyperbili risk factors)
Evaluate for phototherapy and check TcB/TSB in 4-24 hours
 

AAP Phototherapy Guidelines (2004)

Neurotoxicity Risk LevelStart phototherapy?Approximate threshold at
48 hours of age
Lower Risk
(>= 38 weeks and well)
No15.3 mg/dl
Medium Risk
(>=38 weeks + neurotoxicity risk factors OR 35 to 37 6/7 weeks and well)
No13.1 mg/dl
Higher Risk
(35 to 37 6/7 weeks and neurotoxicity risk factors)
Yes11.4 mg/dl

It is an option to provide conventional phototherapy in the hospital or at home at TSB levels 2-3 mg/dl (35-50 µmol/L) below those shown. Home phototherapy should not be used in infants with risk factors.

If phototherapy threshold is exceeded, please also review AAP Guidelines for Exchange Transfusion.