Premie BiliRecsLucile Packard Children's Hospital at Stanford LPCH

A tool for treatment of indirect hyperbilirubinemia in pre-term neonates
weeks
days

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.
Total Serum Bilirubin Trend
Treatment Recommendation

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:

  1. serum albumin levels < 2.5 g/dL
  2. rapidly rising TSB levels suggesting hemolytic disease
  3. 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:

  1. blood pH < 7.15
  2. blood culture positive sepsis in the prior 24 hours
  3. apnea and bradycardia requiring cardio-respiratory resuscitation (bagging and or intubation) during the previous 24 hours
  4. hypotension requiring pressor treatment during the previous 24 hours
  5. mechanical ventilation at the time of blood sampling