Pedemy All toolsEnter the birth date and time; the age in hours is calculated for you. Then get hour-specific phototherapy, escalation and exchange thresholds with next steps.
This calculator applies the AAP 2022 hyperbilirubinemia guideline to newborns born at 35 weeks or later. Enter the birth date and time and the sample time, and it works out the age in hours, then gives hour-specific phototherapy, escalation-of-care and exchange transfusion thresholds with next steps.
The tool asks for gestational age (35 to 40 weeks or more; under 35 weeks is sent to preterm thresholds) and any neurotoxicity risk factors besides gestational age: albumin below 3.0 g/dL, isoimmune hemolysis, G6PD deficiency or other hemolysis, sepsis, or significant clinical instability in the past 24 hours. Risk factors lower the thresholds. You then enter the bilirubin in mg/dL or µmol/L, whether it is serum (TSB) or transcutaneous (TcB), signs of acute bilirubin encephalopathy, and phototherapy status. The escalation threshold is 2 mg/dL below the exchange threshold. Earlier values can be added to plot a trend and flag a rapid rise of 0.3 mg/dL per hour or more in the first 24 hours, or 0.2 mg/dL per hour after.
Results range from follow-up timing based on how far below the phototherapy threshold the value is, to starting or stopping phototherapy, to urgent escalation or exchange transfusion, with an IVIG dose for isoimmune hemolysis. Thresholds come hour by hour from Kemper et al., Pediatrics 2022.
Besides gestational age, the tool lists albumin below 3.0 g/dL, isoimmune hemolysis (positive DAT, ABO or Rh disease), G6PD deficiency or other hemolysis, sepsis, and significant clinical instability in the past 24 hours. Any of these lowers the phototherapy and exchange thresholds.
The tool says to stop when TSB is at least 2 mg/dL below the threshold at the hour phototherapy started. Rebound TSB is checked 6–12 hours after stopping and again the next day if phototherapy started before 48 hours, with a positive DAT or hemolysis; otherwise the next day.
Treatment decisions use TSB. The tool advises measuring TSB when TcB is within 3 mg/dL of the phototherapy threshold, above it, or 15 mg/dL or more. If the TcB is above the phototherapy threshold and the result will be delayed, phototherapy can start while waiting.
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