Lucile Packard Children's Hospital at Stanford LPCH
Premie BiliRecs is designed to help clinicians appropriately prescribe phototherapy or exchange transfusion for infants < 35 weeks post-menstrual age.
Required values include the patient's post-menstrual age* and total bilirubin in either US (mg/dl) or SI (µmol/L) units.
This tool is NOT intended for use in infants <48 hours of age.
* Post-Menstrual Age = Gestational age + Chronological age
Note: Results are based on An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation by Maisels et al. (J Perinatol 2012)
Total Bilirubin: at weeks days
This tool is NOT intended for use in infants <48 hours of age.
Phototherapy Assessment:
| Neurotoxicity Risk Factors | TB Threshold Exceeded | TB Threshold at Weeks Gestation |
|---|---|---|
| Prematurity alone | ||
| Prematurity + additional neurotoxicity risk factors |
Exchange Transfusion Assessment:
| Neurotoxicity Risk Factors | TB Threshold Exceeded | TB Threshold at Weeks Gestation |
|---|---|---|
| Prematurity alone | ||
| Prematurity + additional neurotoxicity risk factors |
* Unable to assess neurotoxicity outcomes related to thresholds above this value
Use the lower range of the listed TSB levels for infants at greater risk for bilirubin toxicity:
- serum albumin levels < 2.5 g/dL
- rapidly rising TSB levels suggesting hemolytic disease
- Those who are clinically unstable
When a decision is being made about the initiation of phototherapy or exchange transfusion, infants are considered to be 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 cardio-respiratory resuscitation (bagging and or intubation) during the previous 24 hours
- hypotension requiring pressor treatment during the previous 24 hours
- mechanical ventilation at the time of blood sampling