Does this newborn require phototherapy?
The newborn is 3 days old (72 hours) at the time of bilirubin measurement, at a gestational age of 39 weeks and 5 days, which classifies as term (≥38 weeks) NICE CG98. The total serum bilirubin level of 18.3 mg/dL converts to approximately 313 micromol/L (1 mg/dL = 17.1 micromol/L), which is a significant hyperbilirubinaemia level NICE CG98. According to the NICE CG98 threshold table for babies ≥38 weeks and at 72 hours (36-78 hours), phototherapy is recommended if the bilirubin level exceeds approximately 225 to 312 micromol/L depending on exact age in hours NICE CG98. Specifically, the phototherapy threshold at 72 hours is around 300 micromol/L NICE CG98. Since 313 micromol/L slightly exceeds the phototherapy threshold at 72 hours, phototherapy should be started NICE CG98.
How many boxes above the phototherapy line in the bilirubin nomogram does this level correspond to?
The bilirubin nomogram used in NICE CG98 has threshold levels marked in increments roughly corresponding to 50 micromol/L steps above or below lines for phototherapy and exchange transfusion NICE CG98. The newborn's level of 313 micromol/L is just above the phototherapy threshold line at 300 micromol/L for 72 hours of age, corresponding roughly to one box above the phototherapy threshold line in the bilirubin nomogram NICE CG98.
Therefore, this newborn requires phototherapy, with the bilirubin level approximately one box above the phototherapy threshold on the nomogram NICE CG98.
Key References
- NICE CG98: Jaundice in newborn babies under 28 days
- NICE CKS: Jaundice in the newborn
- SmPC: AMGLIDIA 6 mg/mL oral suspension with 5 mL oral syringe
- SmPC: AMGLIDIA 6 mg/mL oral suspension with 1 mL oral syringe
- SmPC: AMGLIDIA 0.6 mg/mL oral suspension with 1 mL oral syringe
- SmPC: AMGLIDIA 0.6 mg/mL oral suspension with 5 mL oral syringe