Hour-Specific Bilirubin Risk Assessment (Bhutani Nomogram)
Plots total serum bilirubin (TSB) against postnatal age in hours to categorise risk of severe neonatal hyperbilirubinaemia in infants ≥35 weeks. Based on Bhutani nomogram. Used to guide phototherapy and exchange transfusion decisions.
Score interpretation
TSB in low-risk zone for gestational age and postnatal hours
→ Clinical monitoring; ensure adequate feeding; reassess bilirubin per NICE NG98 schedule; educate parents on signs of worsening jaundice; recheck if age or risk factors change
TSB in intermediate risk zone — high-intermediate zone warrants phototherapy consideration
→ Plot on NICE NG98 phototherapy threshold chart; if above phototherapy threshold, start phototherapy; recheck TSB in 4–6 hours; check DAT/Coombs, G6PD if not done; ensure feeding adequate; paediatric review
TSB in high-risk zone — meets/exceeds phototherapy or exchange transfusion threshold
→ Immediate paediatric/neonatal team review; intensive phototherapy; repeat TSB in 2–4 hours; if TSB at exchange transfusion threshold — urgent senior review, NICU transfer, exchange transfusion preparation; check haemolysis screen, blood group, Coombs; IVIG if isoimmune haemolysis confirmed
Interpretation bands for the Bhutani Bilirubin. Apply clinical judgement and local guidance.
References
- Bhutani VK et al. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics. 1999;103(1):6–14.
- NICE NG98. Jaundice in Newborn Babies under 28 Days. National Institute for Health and Care Excellence. 2016 (updated 2023).
Related
Curated clinical cross-links plus same-class fallbacks.
- Digoxin-specific Antibody Fragments (DigiFab) · Antidote
- Idarucizumab (Praxbind) · Dabigatran reversal agent (specific antidote)
- Digoxin-specific Antibody Fragments (DigiFab) · Antidote
- Digoxin-specific antibody fragments · Digoxin antidote (Fab fragments)
- Colestyramine (Cholestyramine) · Bile Acid Sequestrant / Ion Exchange Resin
- Rozanolixizumab · Neonatal Fc receptor (FcRn) antagonist
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.