ToolsCalculators
Hour-specific risk for neonatal hyperbilirubinemia (Bhutani nomogram)
Predischarge risk zone for subsequent significant hyperbilirubinemia.
Hour-specific risk for neonatal hyperbilirubinemia (Bhutani nomogram)
Postnatal age
hours
Total serum (or transcutaneous) bilirubin
mg/dL
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When to use
- Predischarge or early outpatient risk-stratification of an otherwise well newborn >=35 weeks' gestation to plan bilirubin follow-up timing.
- Not intended for infants already receiving phototherapy or for those <35 weeks' gestation.
Formula
Plots total serum bilirubin against postnatal age (hours) on hour-specific 40th, 75th, and 95th percentile curves derived from 2,840 healthy near-term/term newborns; the risk zone is defined by the highest percentile curve the value equals or exceeds at that hour.
Pearls and pitfalls
- Derived from a DAT-negative cohort of predominantly term/near-term newborns; use cautiously outside that population.
- A high-risk zone value does not by itself mandate phototherapy — compare against separate hour-specific AAP phototherapy thresholds.