Updated Bilirubin Nomogram

TM Bahr et al. J Pediatr 2021; 236: 28-33. A New Hour-Specific Serum Bilirubin Nomogram for Neonates ≥35 Weeks of Gestation

This study which encompassed 397,395 total serum bilirubins provides an updated normogram for serum bilirubins in the first days of life. The data for this nomogram is based on 140 times the number of subjects and is derived from 15 years of universal bilirubin screening (Intermountain Healthcare Hospitals).

Key points:

  • The authors state that this study is one step “toward evidence-based phototherapy decision-making”
  • “We are currently using this nomogram [figure below] routinely in our hospitals in Utah for phototherapy initiation (when a neonate has a TSB exceeding the 95th percentile) and for discharge risk stratification.”
  • “This reduces phototherapy usage…to about 5% of well babies, whereas we had previously been administering phototherapy in 8-10% of well babies.”
  • “Newborns with TSB>75 percentile…receive a recommendation for follow-up within 24 hours.”
  • The authors acknowledge the limitations of their study and caution that more long term outcome data are needed in evaluation of their approach.

My take: Overall, the data is fairly similar to prior data but adoption of these slightly higher values would likely reduce the number of infants requiring phototherapy.

Related blog posts:

In this figure, the new data is indicated by the solid lines and
the prior Bhutani data is indicated by dashed lines.