Hour-specific thresholds for phototherapy in newborns ≥35 weeks gestation with unconjugated hyperbilirubinemia and one or more neurotoxicity risk factors

This figure summarizes the AAP's recommended hour-specific TSB thresholds for initiating phototherapy according to GA (completed weeks) in newborns with one or more risk factor for neurotoxicity. In addition to GA, other risk factors for neurotoxicity include hemolytic conditions, clinical instability in the previous 24 hours, sepsis, and hypoalbuminemia. These thresholds are based on expert opinion as to when the benefits of phototherapy likely exceed its potential harms. Decisions to start phototherapy should be based upon TSB values; do not subtract direct (conjugated) bilirubin from the total value. In rare cases of severe hyperbilirubinemia in which direct (conjugated) bilirubin is >50% of the TSB, consult an expert. If bilirubin testing is performed with TcB, the value should be confirmed with TSB if the TcB value is >15 mg/dL (257 micromol/L) or within 3 mg/dL (51 micromol/L) of the phototherapy threshold. However, if the TcB level is at or above the treatment threshold, phototherapy should be initiated while awaiting TSB confirmation. Note that infants <24 hours old with a TSB at or above the phototherapy threshold are likely to have a hemolytic process and should have additional laboratory evaluation. This figure is intended for use in conjunction with additional UpToDate content. Refer to UpToDate's topics on neonatal hyperbilirubinemia for additional details.