What is the bhutani nomogram?

The Bhutani Nomogram is used to determine the level of risk based on the Infant’s hours of age and serum bilirubin result.

What level of bilirubin is needed for phototherapy?

Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours.

What level of bilirubin requires exchange transfusion?

Cord bilirubin levels >5 mg/dl, bilirubin levels that rise >1 mg/dl/hour, or indirect bilirubin levels >20 mg/dl are all potential indications for exchange transfusion.

How do I start phototherapy?

A commonly used rule of thumb in the NICU is to start phototherapy when the total serum bilirubin level is greater than 5 times the birth weight. Thus, in a 1-kg infant, phototherapy is started at a bilirubin level of 5 mg/dL; in a 2-kg infant, phototherapy is started at a bilirubin level of 10mg/dL and so on.

Why do preterm babies get jaundice?

Infant jaundice is a common condition, particularly in babies born before 38 weeks’ gestation (preterm babies) and some breast-fed babies. Infant jaundice usually occurs because a baby’s liver isn’t mature enough to get rid of bilirubin in the bloodstream.

What is a method used to treat hyperbilirubinemia in a newborn?

Phototherapy. Phototherapy is treatment with a special type of light (not sunlight). It’s sometimes used to treat newborn jaundice by lowering the bilirubin levels in your baby’s blood through a process called photo-oxidation. Photo-oxidation adds oxygen to the bilirubin so it dissolves easily in water.

How quickly does bilirubin drop with phototherapy?

Once your baby’s bilirubin levels have stabilised or started to fall, they’ll be checked every 6 to 12 hours. Phototherapy will be stopped when the bilirubin level falls to a safe level, which usually takes a day or two.

Is 18 a high bilirubin level in newborn?

The bilirubin levels usually fall substantially by day 7. Sometimes, they reach a level at which treatment is needed (>15 mg/dL before 48 hours old, >18 mg/dL before 72 hours old, > 20 mg/dL anytime–in otherwise healthy term babies).

What are the complications of phototherapy?

Side effects — Phototherapy is very safe, but it can have temporary side effects, including skin rashes and loose stools. Overheating and dehydration can occur if a baby does not get enough breast milk or formula. Therefore, a baby’s skin color, temperature, and number of wet diapers should be closely monitored.

Can a bilirubin nomogram be used to predict phototherapy?

Hour-specific bilirubin nomogram and STB measurement can be used for predicting subsequent need of phototherapy. Further studies are needed to validate performance of risk demarcation zones defined in this hour-specific bilirubin nomogram. Bilirubin nomogram for prediction of significant hyperbilirubinemia in north Indian neonates Indian Pediatr.

Can a Bhutani nomogram be used for phototherapy?

However, the Bhutani Nomogram is a different graph from the ones providing phototherapy thresholds, which has sometimes led to confusion and its “high risk” line being used to make phototherapy decisions. The ability to plot (or have the electronic medical record plot) the bilirubin on a single graph should save time and reduce confusion.

When to start intensive phototherapy for hyperbilirubinemia?

Intensive phototherapy can be expected to decrease bilirubin levels by 30-40% in 24 hours, with most being in the first 4-6 hours. Intensive phototherapy should be initiated in the following circumstances: When total bilirubin is at or above the phototherapy treatment threshold based on hour-specific nomograms (Figure 4)

How to diagnose hyperbilirubinemia in newborn babies?

The best documented method for assessing the risk of subsequent hyperbilirubinemia is to measure the TSB or TcB level 25, 31, 35 – 38 and plot the results on a nomogram (Fig 2). A TSB level can be obtained at the time of the routine metabolic screen, thus obviating the need for an additional blood sample.