Newborn Nursery at LPCH

Bilirubin Screening and Management of Hyperbilirubinemia

This document does not represent a comprehensive review of relevant information or recommendations included in the Clinical Practice Guideline released by the AAP Subcommittee of Pediatrics. It is  only meant to be a quick summary/reference of useful points coupled with our approach to bilirubin screening at LPCH. For the complete guideline visit the AAP link below.

 

The Pathophysiology of Hyperbilirubinemia

Guidelines for Phototherapy

The LPCH Approach to Screening

AAP Clinical Practice Guideline

 

Bilirubin Basics:

 

Major Risk Factors for Developing Hyperbilirubinemia:

 

Use of Nomograms and Guidelines:

 

Bilirubin Screening:

 

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Guidelines for Initiating Phototherapy . . .

  . . . IF INFANT IS "LOW RISK"

>38 WEEKS AND OTHERWISE WELL

Age

24 hours

48 hours

72 hours

96 hours

TSB

12 mg/dl

15 mg/dl

18 mg/dl

20 mg/dl

  . . . IF INFANT IS "MEDIUM RISK"

>38 WEEKS WITH RISK FACTOR (see below) OR 35 - 37 WEEKS AND WELL

Age

24 hours

48 hours

72 hours

96 hours

TSB

10 mg/dl

13 mg/dl

15 mg/dl

17 mg/dl

  . . . IF INFANT IS "HIGH RISK"

35-37 WEEKS WITH RISK FACTOR (see below)

Age

24 hours

48 hours

72 hours

96 hours

TSB

8 mg/dl

11 mg/dl

13 mg/dl

15 mg/dl

 

 

RISK FACTORS THAT IMPACT PHOTOTHERAPY RECOMENDATIONS

ISOIMMUNE HEMOLYTIC DISEASE

G6PD DEFICIENCY

ASPHYXIA

LETHARGY

TEMPERATURE INSTABILITY

SEPSIS

ACIDOSIS

ALBUMIN <3 g/dL

BiliTool provides a free, user friendly, interactive way to match patient bili levels to the Bhutani nomogram and phototherapy guidelines.

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the LPCH approach. . .

 

 ABurgos,  reviewed 5-06

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