Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework) — free guideline decision tool

This decision framework operationalizes the AAP 2022 hyperbilirubinemia guideline: it selects the correct threshold curve by gestational age, hours of age and neurotoxicity risk, then applies phototherapy, escalation and exchange logic.

Select curve by GA + hours of age + neurotoxicity risk factors. TSB ≥ phototherapy threshold → intensive phototherapy; TSB ≥ (exchange threshold − 2 mg/dL) → escalation of care (medical emergency); TSB ≥ exchange threshold or acute bilirubin encephalopathy → exchange transfusion. Exact thresholds from the official nomogram.

Use in newborns ≥ 35 weeks with hyperbilirubinemia to choose the right nomogram and structure phototherapy versus exchange decisions.

Decisions use total serum bilirubin (TSB), never TSB minus direct bilirubin, and the exact thresholds must be read from the official AAP 2022 nomogram or calculator. Reaching the exchange threshold minus 2 mg/dL defines 'escalation of care' — a medical emergency requiring NICU transfer, urgent labs, intensive phototherapy and TSB every 2 hours. Gestational age below 38 weeks is itself a risk factor, but the higher-risk Figure 3 curve is used only when additional neurotoxicity risk factors are present.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Gestational age at birth 37 wk, Hours of age 48 h, Neurotoxicity risk factors (beyond GA: hemolysis/DAT+, G6PD, sepsis, marked instability in past 24 h, albumin < 3.0) No additional risk factors, Current total bilirubin TSB (optional, mg/dL) 15 mg/dL → Result: Threshold curve Use 'no risk factors' curve（Curve selection: GA 37 wk, 48 h of age → Figure 2 (35–37⁶ wk, no additional risk factors) / corresponding no-risk-factor curve for GA. Note: GA < 38 wk is itself a risk factor, but if there are no OTHER risk factors still use the no-risk-factor curve (by that GA only); use Figure 3 only when additional risk factors are present, Exact thresholds: Phototherapy and exchange thresholds are continuous nomograms by GA + hours of age; read the exact TSB threshold for this case from the official AAP 2022 figures or calculator (e.g. peditools.org/bili2022) — this tool does not invent specific values, Decision framework: ① TSB ≥ phototherapy threshold → intensive phototherapy (≥ 1 mg/dL above threshold or narrowing gap → inpatient phototherapy); ② TSB ≥ (exchange threshold − 2 mg/dL) → 'escalation of care' medical emergency: transfer to NICU, STAT TSB + direct bilirubin/CBC/albumin/type & crossmatch, intensive phototherapy + IV fluids, TSB every 2 h; ③ TSB ≥ exchange threshold OR signs of acute bilirubin encephalopathy → exchange transfusion. Current TSB = 15 mg/dL, compare with the official curve threshold for this hour of age） Inputs: Gestational age at birth 37 wk, Hours of age 48 h, Neurotoxicity risk factors (beyond GA: hemolysis/DAT+, G6PD, sepsis, marked instability in past 24 h, albumin < 3.0) ≥ 1 present, Current total bilirubin TSB (optional, mg/dL) 15 mg/dL → Result: Threshold curve Use 'with risk factors' curve（Curve selection: GA 37 wk, 48 h of age → Figure 3 (with neurotoxicity risk factors). Note: GA < 38 wk is itself a risk factor, but if there are no OTHER risk factors still use the no-risk-factor curve (by that GA only); use Figure 3 only when additional risk factors are present, Exact thresholds: Phototherapy and exchange thresholds are continuous nomograms by GA + hours of age; read the exact TSB threshold for this case from the official AAP 2022 figures or calculator (e.g. peditools.org/bili2022) — this tool does not invent specific values, Decision framework: ① TSB ≥ phototherapy threshold → intensive phototherapy (≥ 1 mg/dL above threshold or narrowing gap → inpatient phototherapy); ② TSB ≥ (exchange threshold − 2 mg/dL) → 'escalation of care' medical emergency: transfer to NICU, STAT TSB + direct bilirubin/CBC/albumin/type & crossmatch, intensive phototherapy + IV fluids, TSB every 2 h; ③ TSB ≥ exchange threshold OR signs of acute bilirubin encephalopathy → exchange transfusion. Current TSB = 15 mg/dL, compare with the official curve threshold for this hour of age）