Newborn Jaundice and the AAP 2022 Bilirubin Thresholds
Based on the AAP 2022 Clinical Practice Guideline for the management of hyperbilirubinemia in newborns ≥35 weeks gestation (Kemper et al., Pediatrics 2022). Updated July 2026.
Most newborns get at least a little yellow. Bilirubin — the breakdown product of fetal red blood cells — transiently outpaces the newborn liver's ability to clear it, peaking around days 3 to 5. Almost always this resolves on its own. The clinical task is identifying the few infants whose levels are climbing toward the range where bilirubin can injure the brain, and treating them early with phototherapy.
There is no single "treatment number"
The AAP 2022 guideline replaced the old fixed mental cutoffs with hour-specific threshold curves. Whether a bilirubin of, say, 12 mg/dL matters depends on three things:
- Age in hours — thresholds rise steeply over the first days of life, so the same value can be alarming at 24 hours and unremarkable at 96 hours.
- Gestational age — curves are stratified from 35 weeks up; more mature infants tolerate higher levels.
- Neurotoxicity risk factors — isoimmune or other hemolytic disease (including G6PD deficiency), sepsis, clinical instability, or albumin <3.0 g/dL move the infant to lower, more conservative curves.
Compared with the 2004 guideline, the 2022 thresholds are modestly higher — reflecting evidence that the old curves led to some unnecessary phototherapy — and the guideline adds explicit escalation-of-care pathways when levels approach exchange-transfusion range.
Screening and follow-up
Every newborn should have a transcutaneous or total serum bilirubin measured before discharge. What happens next is margin-based: the closer that value sits to the infant's phototherapy threshold, the sooner the outpatient recheck. A baby discharged at 36 hours with a level just under the curve needs eyes on it within a day; a wide margin buys more time.
Do the lookup, not the mental math
Open the Bilirubin Threshold Calculator →
Enter gestational age, age in hours, bilirubin level, and risk factors, and it plots the value against the exact AAP 2022 phototherapy and escalation curves. Always confirm against the published guideline and your institution's protocol.
Frequently asked questions
Is jaundice normal in newborns?
Very common and usually benign — but it needs assessment because a small fraction of infants reach treatment-range levels.
When is phototherapy started?
When the total serum bilirubin crosses the hour-specific AAP 2022 threshold for that infant's gestational age and risk-factor status. There is no single cutoff number.
What are the neurotoxicity risk factors?
Lower gestational age, isoimmune or other hemolytic disease (e.g., G6PD deficiency), sepsis, significant instability, and albumin below 3.0 g/dL.
How is follow-up timed after discharge?
By the margin between the last bilirubin and the phototherapy threshold — smaller margin, earlier recheck, per the guideline's follow-up table.
Source: Kemper AR, et al. Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150(3):e2022058859. For clinical decision support and education only — not a substitute for clinical judgment.