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AAP Phototherapy Thresholds

Based on the 2022 American Academy of Pediatrics clinical practice guideline and adapted for local use by Johns Hopkins All Children's Hospital neonatal hyperbilirubinemia clinical pathway (June 2023).

Illustrative Threshold Plots
Phototherapy thresholds without risk factors
Phototherapy thresholds without neurotoxicity risk factors
Phototherapy thresholds with risk factors
Phototherapy thresholds with neurotoxicity risk factors
Risk Factors for Significant Hyperbilirubinemia
  • Lower gestational age (risk increases with each week <40)
  • Jaundice within the first 24 hours after birth
  • Predischarge TcB/TSB close to the phototherapy threshold
  • Hemolysis with rapid bilirubin rise (>0.3 mg/dL/h in first 24 h or >0.2 mg/dL/h thereafter)
  • Phototherapy before discharge
  • Parent or sibling required phototherapy/exchange
  • Family history/genetic ancestry suggesting inherited RBC disorders (including G6PD deficiency)
  • Exclusive breastfeeding with suboptimal intake
  • Scalp hematoma or significant bruising
  • Down syndrome
  • Macrosomic infant of a diabetic mother
Hyperbilirubinemia Neurotoxicity Risk Factors
  • Gestational age <38 weeks (risk increases with prematurity)
  • Albumin <3.0 g/dL
  • Isoimmune hemolytic disease, G6PD deficiency, or other hemolytic conditions
  • Sepsis
  • Significant clinical instability within the previous 24 hours
Preterm Phototherapy and Exchange Cut-offs (=34 weeks)
Gestation (weeks) Phototherapy (mg/dL) Exchange transfusion (mg/dL)
12 h 24 h 48 h 72 h+ 12 h 24 h 48 h 72 h+
23 3.2 4.0 5.9 7.6 6.1 7.6 10.5 13.5
24 3.2 4.4 6.4 8.2 6.1 7.9 11.1 14.0
25 3.5 4.7 6.7 8.8 6.4 8.2 11.4 14.6
26 3.5 4.7 7.0 9.4 6.4 8.2 11.7 15.2
27 3.6 5.0 7.3 10.0 6.5 8.5 12.0 15.8
28 3.8 5.0 7.6 10.5 6.7 8.5 12.3 16.4
29 3.8 5.3 8.2 11.1 6.7 8.8 12.9 17.0
30 4.0 5.3 8.5 11.7 6.9 8.8 13.2 17.6
31 4.1 5.6 9.0 12.3 7.0 9.1 13.7 18.1
32 4.1 5.9 9.4 12.9 7.0 9.4 14.0 18.7
33 4.2 6.1 9.9 13.5 7.1 9.7 14.6 19.3
34 4.2 6.1 10.2 14.0 7.1 9.7 14.9 19.9
Plot a reference point
Range 0–168 hours; values outside will be clipped.
Chart options
Term thresholds table Conversion assumes 1 mg/dL = 17.1 µmol/L.
Hours Days Phototherapy (µmol/L) Phototherapy (mg/dL) Exchange (µmol/L) Exchange (mg/dL) ≥38w Phototherapy (µmol/L) ≥38w Phototherapy (mg/dL) ≥38w Exchange (µmol/L) ≥38w Exchange (mg/dL)
0 0.00 40.0 2.34 80.0 4.68 100.0 5.85 100.0 5.85
6 0.25 59.2 3.46 104.2 6.09 125.0 7.31 150.0 8.77
12 0.50 78.3 4.58 128.3 7.50 150.0 8.77 200.0 11.70
18 0.75 97.5 5.70 152.5 8.92 175.0 10.23 250.0 14.62
24 1.00 116.7 6.82 176.7 10.33 200.0 11.70 300.0 17.54
30 1.25 135.8 7.94 200.8 11.74 212.0 12.40 350.0 20.47
36 1.50 155.0 9.06 225.0 13.16 225.0 13.16 400.0 23.39
42 1.75 174.2 10.19 249.2 14.57 237.0 13.86 450.0 26.32
48 2.00 193.3 11.31 273.3 15.98 250.0 14.62 450.0 26.32
54 2.25 212.5 12.43 297.5 17.40 262.0 15.32 450.0 26.32
60 2.50 231.7 13.55 321.7 18.81 275.0 16.08 450.0 26.32
66 2.75 250.8 14.67 345.8 20.22 287.0 16.78 450.0 26.32
72 3.00 270.0 15.79 370.0 21.64 300.0 17.54 450.0 26.32
78 3.25 270.0 15.79 370.0 21.64 312.0 18.25 450.0 26.32
84 3.50 270.0 15.79 370.0 21.64 325.0 19.01 450.0 26.32
90 3.75 270.0 15.79 370.0 21.64 337.0 19.71 450.0 26.32
96 4.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
102 4.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
108 4.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
114 4.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
120 5.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
126 5.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
132 5.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
138 5.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
144 6.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
150 6.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
156 6.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
162 6.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
168 7.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
174 7.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
180 7.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
186 7.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
192 8.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
198 8.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
204 8.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
210 8.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
216 9.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
222 9.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
228 9.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
234 9.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
240 10.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
246 10.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
252 10.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
258 10.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
264 11.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
270 11.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
276 11.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
282 11.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
288 12.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
294 12.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
300 12.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
306 12.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
312 13.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
318 13.25 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
324 13.50 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
330 13.75 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32
336 14.00 270.0 15.79 370.0 21.64 350.0 20.47 450.0 26.32