Risk Assessment
Term newborn, 24 hours old, TSB 6 mg/dL
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Evidence-based calculations Used in clinical settings worldwide Regular monitoring recommended
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Clinical Scenarios
✅ Low Risk (24 hours)
Term newborn, 24 hours old, TSB 6 mg/dL
⚠️ Intermediate Risk (48 hours)
38-week infant with elevated bilirubin
🔴 High Risk - ABO
Term infant with ABO incompatibility
👶 Late Preterm (35 weeks)
Late preterm infant at higher risk
🚨 At Phototherapy Threshold
Newborn at phototherapy treatment threshold
🆘 Near Exchange Threshold
Critical hyperbilirubinemia
Bilirubin Values
Patient Information
Risk Factor Assessment
For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.
🏥 Health Facts
— WHO
— CDC
What is Newborn Hyperbilirubinemia?
Neonatal hyperbilirubinemia (jaundice) occurs when unconjugated bilirubin accumulates faster than the newborn's liver can conjugate and excrete it. While physiologic jaundice affects 60% of term and 80% of preterm newborns, severe hyperbilirubinemia can cause acute bilirubin encephalopathy (ABE) and permanent neurological damage (kernicterus).
Physiologic Jaundice
- • Appears after 24 hours of life
- • Peaks day 3-5
- • TSB typically <12-15 mg/dL
- • Resolves by 2 weeks
Pathologic Jaundice
- • Appears within 24 hours
- • TSB rise >5 mg/dL/day
- • TSB >95th percentile
- • Persists >2 weeks
Kernicterus Warning Signs
- • High-pitched cry
- • Opisthotonus (arching)
- • Hyper/hypotonia
- • Poor feeding, lethargy
Kramer Zones - Visual Jaundice Assessment
Head and neck
4-8 mg/dL
Upper trunk
5-12 mg/dL
Lower trunk and thighs
8-16 mg/dL
Arms and lower legs
11-18 mg/dL
Hands and feet
>15 mg/dL
Note: Visual assessment is unreliable, especially in darker skin tones. Always confirm with serum/transcutaneous bilirubin measurement.
How Does the Bhutani Nomogram Work?
Risk Stratification
The Bhutani nomogram plots TSB against postnatal age in hours to determine risk zone:
- Low Risk: <40th percentile
- Low-Intermediate: 40-75th percentile
- High-Intermediate: 75-95th percentile
- High Risk: >95th percentile
Treatment Thresholds
AAP guidelines adjust thresholds based on:
- • Gestational age (lower thresholds for preterm)
- • Postnatal age in hours
- • Presence of neurotoxicity risk factors
- • Albumin level (B/A ratio)
Neurotoxicity Risk Factors
Major Risk Factors (Lower Threshold)
- • Isoimmune hemolytic disease (ABO, Rh)
- • G6PD deficiency
- • Asphyxia, acidosis, sepsis
- • Significant lethargy
- • Gestational age <38 weeks
- • Albumin <3.0 g/dL
Minor Risk Factors
- • Cephalhematoma/significant bruising
- • Exclusive breastfeeding with poor intake
- • Previous sibling with jaundice
- • East Asian ethnicity
- • Male sex
- • Maternal age >25
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