Treatment with home phototherapy requirements:  

• Gestational age ≥38 weeks, ≥48 hours old 

• Clinically well with adequate feeding 

• No neurotoxicity risk factors, no previous PT 

• TSB no more than 1 mg/dL above the PT threshold  

• Bili blanket can be obtained quickly, TSB can be measured daily 

Monitoring phototherapy: 

• Consider H/H to assess for anemia/baseline Hct

• In hospital? Check TSB 1- 12h after starting PT - clinical judgement 

• At home? Check TSB daily. If the threshold narrows or the TSB is ≥1 mg/dL above the PT threshold, readmit

Discontinuing phototherapy:

• TSB has decreased by at least 2 mg/dL below the hour-specific threshold at the initiation of PT

Repeat TSB measurement after PT is based on the risk of rebound: 

• Infants who exceeded the PT threshold during the birth hospitalization and (1) received PT <48h of age; (2) had a +DAT; or (3) known/suspected hemolytic dz --> TSB 6-12h after PT and trend on the day after PT

Neurotoxicity risk factors: 

• • gestation age <38w

  • sepsis

  • hemolysis (+DAT, G6PD)

  • albumin <3

  • significant clinical instability in last 24h

Rarer scenarios: 

• Breastfed infants jaundiced at 3-4w, or formula-fed infants jaundiced at 2w, measure total + direct bili to assess pathologic cholestasis

• If  TSB increases despite PT, TSB increases suddenly or increases after an initial decline, or approaches exchange: consider G6PD 

Escalation and exchange transfusion: 

• Care is escalated when TSB < 2 mg/dL below the exchange threshold

• Escalation = STAT total and direct bilirubin, CBC, CMP, type and crossmatch, G6PD activity. IV hydration, emergent PT, consult NICU

• Measure TSB q2h until lower than escalation threshold  

• Exchange transfusion indications: encephalopathy (hypertonia, arching, retrocollis, opisthotonos, high-pitched cry, or recurrent apnea), or TSB > exchange threshold