Phototherapy Threshold
Based on the landmark 2022 AAP Clinical Practice Guideline (Kemper et al.), this calculator provides hour-specific TSB thresholds for phototherapy initiation, escalation to intensive phototherapy, and exchange transfusion — stratified by gestational age and neurotoxicity risk factors. The 2022 guideline raised thresholds compared to 2004 and introduced a gestational age–specific risk-stratified approach.
Key changes in 2022 vs 2004 AAP guideline
- Thresholds now vary continuously by gestational age (35–40+ weeks), not just by risk category
- Neurotoxicity risk factors defined explicitly (DAT+, G6PD, albumin <3.0, clinical instability)
- Escalation zone introduced between conventional and exchange transfusion thresholds
- Overall thresholds raised ~1–3 mg/dL vs 2004 guideline
Whole weeks (≥35)
Hours since birth (0–360)
Other than GA: DAT+, G6PD, albumin <3.0, sepsis/instability
Nomogram for 36w GA
Hyperbilirubinemia neurotoxicity risk factors
- Gestational age <38 weeks (already reflected by the GA-specific curves)
- Isoimmune hemolytic disease (positive DAT), G6PD deficiency, or other hemolytic conditions
- Albumin < 3.0 g/dL
- Sepsis or significant clinical instability in the previous 24 hours
Kemper AR, Newman TB, Slaughter JL, et al. Pediatrics. 2022;150(3):e2022058859, Supplemental Tables 1–4. Escalation-of-care threshold = exchange − 2 mg/dL. TcB confirmation (KAS 6): obtain a serum TSB if the TcB is within 3 mg/dL of the phototherapy threshold or ≥ 15 mg/dL.
Frequently asked questions
Which infants does this apply to?
Newborn infants of 35 or more weeks' gestation, per the 2022 AAP clinical practice guideline.
When should a TcB be confirmed with a serum TSB?
When the transcutaneous bilirubin is within 3 mg/dL of the phototherapy threshold or is 15 mg/dL or higher.
What is the escalation-of-care threshold?
It is defined as 2 mg/dL below the exchange transfusion threshold.
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