This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.
AAP Bilirubin 2022
Newborns ≥ 35 weeks of gestation: phototherapy, escalation and exchange thresholds, follow-up, course
About this calculator
Assesses one or more bilirubin values according to the AAP guideline 2022 (Kemper et al.). Output: hour-specific phototherapy and exchange transfusion thresholds by gestational age and neurotoxicity risk factors, escalation-of-care threshold (2 mg/dl below exchange), distance to the threshold, recommended follow-up after discharge and nomogram with all measurement points.
Cut-offs from Supplemental Tables 1–4 of the guideline (hour-specific, 1–336 h). For infants with risk factors there are curves for 35, 36, 37 and ≥ 38 weeks; without risk factors 35 to ≥ 40 weeks (phototherapy) and 35 to ≥ 38 weeks (exchange), respectively. Direct bilirubin is not subtracted. For values at or above the escalation threshold: immediate work-up (TSB/direct bilirubin, blood count, albumin, blood group/DAT), intensive phototherapy, IVIG if indicated in isoimmune hemolysis – see Figure 4 of the guideline.
Frequently asked questions
What has changed with the AAP guideline 2022?
The phototherapy and exchange thresholds are higher than 2004 and are given hour by hour according to gestational age (35 to ≥ 40 weeks). New are the escalation-of-care threshold (2 mg/dl below the exchange threshold) and follow-up recommendations based on the distance from the phototherapy threshold.
Which neurotoxicity risk factors count?
According to Table 2 of the guideline: gestational age below 38 weeks, albumin below 3.0 g/dl, isoimmune hemolysis (positive DAT), G6PD deficiency or other hemolysis, sepsis and marked clinical instability in the last 24 hours. Gestational age enters through the choice of curve.
Is direct bilirubin subtracted?
No. The guideline requires using total bilirubin and not subtracting direct or conjugated bilirubin.
When should a serum value be determined from a TcB value?
If the transcutaneous value reaches the phototherapy threshold, is less than 3 mg/dl below it, or is 15 mg/dl or more.
Does the calculator apply to preterm infants under 35 weeks?
No. The AAP guideline 2022 applies to newborns from 35+0 weeks. For smaller preterm infants, the calculator according to AWMF 024-007 is available.