👶 Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework)
UseUse in newborns ≥ 35 weeks with hyperbilirubinemia to choose the right nomogram and structure phototherapy ve…
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SourceKemper AR, et al. AAP Clinical Practice Guideline: Management of Hyperbilirubinemia in the Newborn …
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋ASCVD / China-PAROpen scene pack →Related scores
Matching pathway
🧭htn_emergencyOpen pathway →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
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.
When to use
Use in newborns ≥ 35 weeks with hyperbilirubinemia to choose the right nomogram and structure phototherapy versus exchange decisions.
How it works
TSB ≥ phototherapy threshold → intensive phototherapy;[pending update] → 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.
References
- [Guideline / primary source]Kemper AR, et al. AAP Clinical Practice Guideline: Management of Hyperbilirubinemia in the Newborn ≥ 35 Weeks. Pediatrics 2022.
- [Guideline / primary source]PediTools bilirubin (AAP 2022) calculator.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| 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 |
→Threshold curveUse '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);[pending update]→ '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
| 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 |
→Threshold curveUse 'with risk factors' curve
- Curve selection：GA 37 wk, 48 h of age → [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text.. 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);[pending update]→ '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
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework)?
- 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.
- Does Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Neonatal Hyperbilirubinemia Phototherapy/Exchange (AAP 2022 Framework) calculated in practice? Can you show a worked example?
- 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);[pending update]→ '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 → [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text.. 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);[pending update]→ '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）