Clinical tools for pediatric providers

Hyperbilirubinemia Management from 27 - 40+ weeks

Clinical decision support for neonatal hyperbilirubinemia based on the AAP 2022 and Stanford Premie BiliRecs guidelines.

The guideline is chosen from gestational age at birth and age:

  • Born at 35 or more weeks: AAP 2022
  • Born before 35 weeks, now 27 0/7 to 35 0/7 weeks postmenstrual age: Stanford Premie BiliRecs (not intended for infants < 48 hours of age)
  • Out of range: Born before 35 weeks, now beyond 35 0/7 weeks postmenstrual age: recommendations from both for comparison (Stanford Premie BiliRecs at 35 0/7 weeks PMA, and AAP 2022 as if born at 35 completed weeks)

Age and Bilirubin
Neurotoxicity risks
(required for AAP 2022)
Plot scale (AAP 2022)
Gap analysis (born < 35, PMA > 35)
Reset form


Optional age calculator


Usage Notes

  • Gestation at birth, enter as ## #/7; e.g. 30 3/7 for 30 weeks and 3 days gestation
  • At 35+ weeks, days are not needed
  • Can leave bilirubin blank to view thresholds
  • Enter a comma-separated list of ages and bilirubin levels to assess trends
    • Management recommendations will be based on the latest age

Neurotoxicity Risk Factors: AAP 2022

  • albumin < 3 g/dL
  • isoimmune hemolytic disease
  • G6PD deficiency
  • other hemolytic conditions
  • sepsis
  • clinical instability in previous 24 hours
  • (prematurity accounted for by distinct threshold curves)

Neurotoxicity Risk Factors: Stanford Premie BiliRecs

  • serum albumin levels < 2.5 g/dL
  • rapidly rising TSB levels suggesting hemolytic disease
  • clinically unstable, if they have one or more of the following conditions:
    • blood pH < 7.15
    • blood culture positive sepsis in the prior 24 hours
    • apnea and bradycardia requiring cardiorespiratory resuscitation (bagging or intubation) during the previous 24 hours
    • hypotension requiring vasopressor treatment during the previous 24 hours
    • mechanical ventilation at the time of blood sampling

Based on

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© 2012 – 2026 Joseph Chou