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
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
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 |
Sources and Reference Basis
This page is a clinical reference aid for neonatal jaundice threshold review. Use current local policy, infant-specific risk assessment, and confirm bilirubin units before treatment decisions.
- American Academy of Pediatrics 2022 Hyperbilirubinemia Guideline Primary guideline for management of hyperbilirubinemia in newborn infants 35 or more weeks of gestation.
- Johns Hopkins All Children Hospital Neonatal Hyperbilirubinemia Clinical Pathway Local pathway adaptation used here for bedside threshold display and charting.
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Frequently Asked Questions
Which infants do the AAP phototherapy thresholds apply to?
The AAP 2022 hyperbilirubinemia guideline applies to newborn infants at least 35 weeks gestation, with different thresholds depending on age in hours, gestation, and neurotoxicity risk factors.
Why are bilirubin thresholds plotted by hours of age?
Treatment thresholds change rapidly after birth, so postnatal age in hours is needed for accurate phototherapy and exchange transfusion threshold review.
What risk factors lower the treatment threshold?
Neurotoxicity risk factors include lower gestational age, low albumin, hemolytic disease, G6PD deficiency or other hemolysis, sepsis, and recent clinical instability.