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*Note: The default unit of measure for total bilirubin is mg/dl. Please select µmol/L if your bilirubin values are captured in the global standard SI metric units. Bilirubin conversion from US to SI units is 17.1.

Results are based on the Hour-Specific Nomogram for Risk Stratification published in "Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation" (2004) by the AAP journal.

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Stuart Turner, Leafpath Informatics, stuart.turner (at) leafpath (dot) org

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Note: The default unit of measure for total bilirubin is mg/dl. Please select µmol/L if your bilirubin values are captured in the global standard SI metric units. Bilirubin conversion from US to SI units is 17.1.

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If more than 1 bilirubin measure is available, the rate of rise can be calculated to risk stratify. A rapid rate of rise (>0.3 mg/dL per hour in the first 24 hours or >0.2 mg/dL per hour thereafter) are high risk for subsequent development of hyperbilirubinemia.

- Consider phototherapy even if not at threshold
- Obtain DAT if not previously done

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For infants requiring phototherapy, measure the hemoglobin, hematocrit, or complete blood count to assess for the presence of anemia and to provide a baseline in case subsequent anemia develops.

Obtain a DAT in infants whose mother had a positive antibody screen or whose mother is blood group O regardless of Rh(D) status or whose mother is Rh(D)-.

For serum bilirubin increasing despite intensive phototherapy, consider Hematology consultation for work-up for other causes of hemolysis.

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- Serum bilirubin should be re-checked within 12 hours of starting phototherapy.

- Discontinuing phototherapy is an option when serum bilirubin has decreased by at least 2 mg/dL below the threshold at the initiation of phototherapy.

- Obtain a level at the time of discontinuing phototherapy.

- Follow-up
- Obtain serum bilirubin within 6 hours of discontinuation for DAT positive infants, infants who were started on phototherapy within 48 hours of birth, concern for another type of hemolytic process.
- Obtain serum bilirubin within 24 hours of discontinuation for all other infants.

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Use of IV fluids is not recommended unless there is evidence of dehydration that cannot be corrected enterally or if the serum bilirubin exceeds the escalation of care threshold.

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- STAT Labs: Total and direct serum bilirubin, CBC, CMP, and type and crossmatch
- Trend total serum bilirubin q2h
- Begin IV hydration, continue PO hydration
- Consider IVIg
- Consult NICU for transfer while continuing phototherapy

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Infants with signs of intermediate or advanced stages of acute bilirubin encephalopathy including hypertonia, arching, retrocollis, opisthotonos, highpitched cry, recurrent apnea, or serum bilirubin above the exchange transfusion threshold.