Premie BiliRecsLucile Packard Children's Hospital at Stanford LPCH

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

Use:

Premie BiliRecs is designed to help clinicians decide when to initiate phototherapy and double volume exchange transfusion for infants < 35 weeks PMA.

Required values include the age of the child by Post-Menstrual Age, and the 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 suggested use of phototherapy in preterm infants < 35 weeks gestational age published in An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation (2012) by the Journal of Perinatology.

Total Bilirubin: at weeks days

Total Serum Bilirubin Trend
Treatment Recommendation

Phototherapy Assessment:

Neurotoxicity Risk Factors TB Threshold Exceeded Approximate threshold at weeks gestation
Prematurity + additional neurotoxicity risk factors
Prematurity alone

Exchange Transfusion Assessment:

Neurotoxicity Risk Factors TB Threshold Exceeded Approximate threshold at weeks gestation
Prematurity + additional neurotoxicity risk factors
Prematurity alone

* Unable to assess neurotoxicity outcomes related to thresholds above this value

Neurotoxicity Risk Factors

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

This tool is NOT intended for use in infants <48 hours of age.