Phototherapy Guidelines - When to treat : 35 or more weeks gestation

 

Term and Near-Term Babies: >36 Weeks Gestational Age, BW > 2000 g

Risk of Developing Clinically Significant Hyperbilirubinemia

* Risk = Probability that patient will require close supervision, further evaluation or intervention if brain damage is to be prevented without resorting to exchange transfusion

"The Predictive ability of a pre-discharge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term infants."  VK Bhutani, et al, Pediatrics, 1999
 
Term infant management of hyperbilirubinemia (AAP): > 37 weeks, > 2,000 g
Age
 (Hours)		 Healthy
Total Serum Bilirubin (mg/dL)		 Sick
Total Serum Bilirubin (mg/dL)
  Phototherapy Exchange Transfusion Phototherapy Exchange Transfusion
< 24 10 - 12 20 7 - 10 18 - 20
25 - 48 12 - 15 20 - 25 10 - 12 > 20
48 - 72 15 - 18 25 - 30 12 - 15 > 20
> 72 18 - 20 25 - 30 12 - 15 > 20
Pediatrics 1994;94:558-565 & 1995;95:458-4
Gartner LM. Pediatrics in Review 1994;15:422-432
 
Premature infant management of hyperbili: < 37 wks, or < 2,000 g
Weight
(grams)		 Healthy
Total Serum Bilirubin (mg/dL)		 Sick
Total Serum Bilirubin (mg/dL)
Phototherapy Exchange Transfusion Phototherapy Exchange Transfusion
< 1,000 5 - 7 10 4 - 6 8 - 10
1,001 - 1,500 7 - 10 10 - 15 6 - 8 10 - 12
1,501 - 2,000 10 17 8 - 10 15
> 2,000 10 - 12 18 10 17
Halamek LP, Stevenson DK. Neonatal Jaundice and liver diseases. In: Neonatal Perinatal Medicine: Diseases of the fetus and infant. Sixth edition, Fanaroff AA, Martin RJ, eds. St. Louis, Mosby-Year Book Inc. 1345-1389, 1997

Gartner LM. Pediatrics in Review 1994;15:422-432

 

Phototherapy if rate of total bilirubin rise is:
> 0.5 mg/dL per hour
> 5 mg/dL per day
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