👶 Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework)
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.
Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework)
Gestational age at birth (wk)
Hours of age (h)
Neurotoxicity risk factors (beyond GA: hemolysis/DAT+, G6PD, sepsis, marked instability in past 24 h, albumin < 3.0)
Current total bilirubin TSB (optional, mg/dL) (mg/dL)
When to use
Use in newborns ≥ 35 weeks with hyperbilirubinemia to choose the right nomogram and structure phototherapy versus exchange decisions.
How it works
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.
Key points
- 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.
References
- Kemper AR, et al. AAP Clinical Practice Guideline: Management of Hyperbilirubinemia in the Newborn ≥ 35 Weeks. Pediatrics 2022.
- PediTools bilirubin (AAP 2022) calculator.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.