Patient Information
Neurotoxicity Risk Factors
About These Guidelines
AAP 2022 Guidelines: Thresholds are based on gestational age and neurotoxicity risk
factors.
Applies to infants ≥35 weeks. The guidelines provide phototherapy and exchange transfusion
thresholds
to guide clinical management of hyperbilirubinemia.
Based on AAP 2022 (Kemper et al., Pediatrics 2022;150(3):e2022058859). doi:10.1542/peds.2022-058859
NICE Guidelines (CG98): Based on gestational age-specific treatment threshold graphs. Applies to infants from 23 weeks gestation. NICE uses μmol/L as the primary unit of measurement.
Disclaimer: This calculator is for educational and reference purposes only. Always consult current clinical guidelines and experienced clinicians for patient care decisions.
Preterm infants (<35 weeks)
The AAP 2022 thresholds above apply only to infants ≥35 weeks. For preterm infants <35 weeks, the consensus-based operational thresholds below (total serum bilirubin, mg/dL) are widely used.
| Gestational age (weeks) | Initiate phototherapy TSB (mg/dL) | Exchange transfusion TSB (mg/dL) |
|---|---|---|
| <28 0/7 | 5–6 | 11–14 |
| 28 0/7 – 29 6/7 | 6–8 | 12–14 |
| 30 0/7 – 31 6/7 | 8–10 | 13–16 |
| 32 0/7 – 33 6/7 | 10–12 | 15–18 |
| 34 0/7 – 34 6/7 | 12–14 | 17–19 |
- Use the lower end of the range for infants at greater risk of bilirubin toxicity: lower gestational age, serum albumin <2.5 g/dL, rapidly rising TSB (suggesting hemolytic disease), or clinical instability.
- After the first week, use postmenstrual age (e.g., a 29 0/7-week infant at 7 days: use the 30 0/7 thresholds).
- Use total bilirubin; do not subtract direct-reacting or conjugated bilirubin.
- Exchange thresholds apply to infants already receiving intensive phototherapy whose TSB continues to rise; exchange is recommended for any infant with signs of acute bilirubin encephalopathy.
Source: Maisels MJ, Watchko JF, Bhutani VK, Stevenson DK. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol 2012;32:660–664, Table 1. doi:10.1038/jp.2012.71
Clinical judgment required: These consensus-based values are a static reference, are not used by the calculator above, and do not replace local protocols or senior clinical judgment.
References
- Kemper AR, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (AAP 2022). Pediatrics. 2022;150(3):e2022058859. doi:10.1542/peds.2022-058859
- NICE. Jaundice in newborn babies under 28 days. Clinical guideline CG98 (2010, updated 2023). www.nice.org.uk/guidance/cg98
- Maisels MJ, Watchko JF, Bhutani VK, Stevenson DK. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol. 2012;32:660-664. doi:10.1038/jp.2012.71
Reviewed by Dr. Mahmoud M. Ahmed, Consultant Neonatologist. Last reviewed: 26 October 2026. How we review content