Hour-Specific Risk for Neonatal Hyperbilirubinemia

Bhutani Nomogram Calculator

Total Serum Bilirubin

mg/dL

Age of Neonate

hours

Risk Zone: –

Awaiting input

Enter TSB and age in hours.

Predicts risk of hyperbilirubinemia in neonates.

Why Use

The American Academy of Pediatrics (AAP) recommends risk assessment for developing severe hyperbilirubinemia in every neonate. Helps determine timing for follow up visits.

When to Use

Neonates ≥35 weeks GA at the time of discharge. Do not use in neonates with positive direct Coombs test, or in those requiring phototherapy before 60 hours of age. The recommendations listed here for starting phototherapy are based on AAP guidelines . Always use clinical judgment, in addition to considering evidence-based clinical guidelines, in making treatment decisions. Do not use to determine need for exchange transfusion.

Formula

Nomogram for risk of hyperbilirubinemia: Nomogram from AAP guidelines (Figure 2). For exact values (starting at 18 hours old), refer to Table 1 in Stevenson 2001 . Nomogram for phototherapy: Nomogram from AAP guidelines (Figure 3).

Pearls / Pitfalls

Predicts risk of subsequent severe hyperbilirubinemia in neonates ≥35 weeks GA at the time of discharge. Only total serum bilirubin should be used (i.e., not direct or indirect).

Management

An infant whose predischarge total serum bilirubin is in the low risk zone is at very low risk for developing severe hyperbilirubinemia. Appropriate follow up after discharge must be ensured regardless of method of risk assessment used. Infant discharged Should be seen by age Before 24 hrs 72 hrs Between 24 and 48 hrs 96 hrs Between 48 and 72 hrs 120 hrs From AAP guidelines .

Critical Actions

Clinical judgment should guide follow up. Neonates at higher risk and with clinical risk factors may be followed earlier.

Advice

The risk calculator is one of two clinical options recommended by the AAP for risk assessment (either clinical risk factors alone or in combination with the risk calculator). Most important clinical risk factors to consider include: breastfeeding, GA <38 weeks, significant jaundice in a sibling (defined as requiring phototherapy), and jaundice noted before discharge ( Newman 2000 ).

More Information

Interpretation: Percentile Hour-specific t otal serum bilirubin ( TSB) risk zone Probability of subsequent neonatal hyperbilirubinemia ≥95th High 39.5% 76th-94th High-intermediate 12.9% 40th-75th Low-intermediate 2.2% <40th Low 0% From Bhutani 1999 .