Neonatal Jaundice Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Stratify against the nomogram
   Transcutaneous/serum bilirubin against the AAP nomogram — which treatment threshold is reached? (Neonatal unconjugated hyperbilirubinemia, untreated can cause acute bilirubin encephalopathy → kernicterus. Screen TcB/TSB in the first 24–48 h, by the hour-specific nomogram (AAP 2022, separate curves for gestational age ≥35 weeks). Neurotoxicity risk factors: gestational age <38 weeks, albumin <3.0, isoimmune hemolysis (ABO/Rh, DAT positive), G6PD deficiency (common in southern China), sepsis, instability. Test for hemolysis (ABO/Rh/G6PD); onset <24 h/rapid rise/prolonged (>2–3 weeks check direct bilirubin to exclude biliary atresia) needs further evaluation.)
   • At exchange threshold or signs of acute bilirubin encephalopathy → At exchange threshold → exchange transfusion
   • At phototherapy threshold → At phototherapy threshold · phototherapy
   • Below threshold → Below threshold · follow up
2. [End] Below threshold · follow up
   Schedule follow-up re-testing by gestational age/risk factors/bilirubin trajectory; ensure feeding and hydration; investigate and treat the cause (hemolysis/G6PD); jaundice education for parents.
3. [End] At phototherapy threshold · phototherapy
   At the phototherapy threshold (by gestational age + hours of life + risk factors nomogram): intensive phototherapy (first-line), ensure hydration and feeding; within 2 mg/dL of the exchange threshold → intensive phototherapy + IV fluids, STAT TSB/direct bilirubin/CBC/albumin/crossmatch, TSB q2h. Monitor for rebound after phototherapy.
4. [End] At exchange threshold → exchange transfusion
   At the exchange threshold (still reached under intensive phototherapy) or signs of acute bilirubin encephalopathy: exchange transfusion (urgent bilirubin removal); add IVIG for isoimmune hemolysis; continue intensive phototherapy, aggressive hydration, correct precipitants; NICU, pediatric consult.

Source guidelines & references

• AAP 2022 clinical guideline for neonatal hyperbilirubinemia

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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