Recommendation extraction for this topic is still in progress. Original sources are below; this is not completed quick-reference coverage.
Hepatitis B — routine series
United States · AAP/CDC infant immunization · Birth–23 months
Birth · 1–2 months · 6–18 months
Give the infant HepB series. For a medically stable newborn of an HBsAg-negative mother with birth weight ≥2,000 g, give the first dose within 24 hours.
Use single-antigen HepB before 6 weeks of age. A combination vaccine after the birth dose can produce a valid four-dose series.
Conditions, related rules & sources for Hepatitis B — routine series
- The final dose must be at age ≥24 weeks. Birth weight <2,000 g and positive/unknown maternal HBsAg have separate timing below.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — birth weight under 2,000 g, maternal test negative
United States · AAP/CDC infant immunization · Birth–23 months
Chronological age 1 month or discharge, whichever is earlier · Conditional
For an infant born to an HBsAg-negative mother with birth weight <2,000 g, give the first HepB dose at one month or hospital discharge, whichever comes first—even if still under 2,000 g.
- This deferral does not apply to infants of HBsAg-positive or unknown-status mothers. CDC’s perinatal table places the next single-antigen dose at 2 months and the final dose at 6–18 months, not before 24 weeks.
Related rule sources & dates
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight ≥2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Single-antigen vaccine within 12 hours of birth · Conditional
Give HepB promptly and determine maternal HBsAg status as soon as possible. If the mother is positive, give HBIG as soon as possible in a separate limb, no later than age 7 days.
- If maternal infection is otherwise evident (HBV DNA, HBeAg positivity or known chronic HBV), manage as maternal HBsAg-positive from the start.
- Final dose: age 6 months, minimum 24 weeks. If maternal status becomes positive or remains unknown, test HBsAg and anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; not before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight <2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and HBIG in separate limbs within 12 hours. Give three more vaccine doses starting at one month; the birth dose does not count toward the three-dose series.
- Do not delay immunoprophylaxis while waiting for maternal testing. Final dose: age 6 months, minimum 24 weeks.
- If maternal status becomes positive or stays unknown, test HBsAg/anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; never before 9 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Rotavirus — product-specific series
United States · AAP/CDC infant immunization · Birth–23 months
Rotarix: 2 & 4 months · RotaTeq: 2, 4 & 6 months
Give two doses of Rotarix or three doses of RotaTeq. If any prior dose was RotaTeq or the product is unknown, use a three-dose series.
Earliest first dose: 6 weeks. Start no later than 14 weeks, 6 days; do not start at ≥15 weeks. Finish all doses by 8 months, 0 days. Minimum interval: 4 weeks.
Conditions, related rules & sources for Rotavirus — product-specific series
- SCID, previous intussusception, or severe allergy to a prior dose/component are contraindications. Other immunocompromise, chronic gastrointestinal disease, moderate/severe acute illness, and RV1 with spina bifida or bladder exstrophy are precautions.
- NICU timing is body-specific; see the separate hospitalized-infant result.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Rotavirus — CDC hospitalized-infant timing
United States · AAP/CDC infant immunization · Birth–23 months
Stable, age-eligible infant · at or after NICU discharge · Conditional
CDC recommends deferring rotavirus vaccine until discharge when an infant ≥6 weeks old has remained in hospital since birth. The first dose must still be before 15 weeks, 0 days.
CDC-specific NICU timing; AAP NICU passage not yet summarized
- This is CDC’s stated NICU timing. It is not attributed to AAP’s current NICU position, which is not reproduced here without the original current Red Book passage.
- The AAP original chapter is linked in Coverage & sources; no AAP inpatient recommendation is inferred from a research article or journal blog.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
DTaP — primary series & first booster
United States · AAP/CDC infant immunization · Birth–23 months
2, 4 & 6 months · booster at 15–18 months
Give the three-dose infant primary series and the first booster. The later routine booster is at 4–6 years, beyond this collection’s age scope.
Minimum starting age: 6 weeks. Kinrix and Quadracel are not infant products (minimum age 4 years).
Conditions, related rules & sources for DTaP — primary series & first booster
- For a planned early fourth dose, the child must be ≥12 months and ≥6 months beyond dose 3. Do not substitute the retrospective four-month validation interval for planned timing.
- A severe prior allergy or unexplained encephalopathy within 7 days of DTP/DTaP contraindicates DTaP. Progressive neurologic disease is a precaution until clarified/stable.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — ActHIB, Hiberix, Pentacel or Vaxelis
United States · AAP/CDC infant immunization · Birth–23 months
2, 4 & 6 months · booster at 12–15 months
Give a three-dose primary series followed by a Hib booster.
Do not use Vaxelis for the booster; choose another Hib-containing product. Minimum starting age: 6 weeks.
Conditions, related rules & sources for Hib — ActHIB, Hiberix, Pentacel or Vaxelis
- For American Indian and Alaska Native infants, Vaxelis or PedvaxHIB is preferred for the primary series.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — PedvaxHIB series
United States · AAP/CDC infant immunization · Birth–23 months
2 & 4 months · booster at 12–15 months
With PedvaxHIB, give a two-dose primary series and a booster, for three doses total.
Minimum starting age: 6 weeks. Product choice matters; the other infant Hib products use a three-dose primary series.
Conditions, related rules & sources for Hib — PedvaxHIB series
- Vaxelis or PedvaxHIB is preferred for primary immunization of American Indian and Alaska Native infants.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Pneumococcal conjugate — infant series
United States · AAP/CDC infant immunization · Birth–23 months
2, 4 & 6 months · booster at 12–15 months
Give four doses of PCV15 or PCV20. The minimum starting age is 6 weeks.
Do not add PCV20 solely because it is newer when a child without risk conditions already has a complete age-appropriate PCV series.
Conditions, related rules & sources for Pneumococcal conjugate — infant series
- PPSV23 starts at age 2 years; it is not an infant substitute for conjugate vaccine. A severe allergy to a prior dose/component or a diphtheria-toxoid-containing vaccine is a contraindication.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Inactivated polio — infant doses
United States · AAP/CDC infant immunization · Birth–23 months
2 & 4 months · third dose at 6–18 months
Give the first three IPV doses in infancy. The final routine dose is at age ≥4 years and ≥6 months after the prior dose, even if a combination product gave four doses earlier.
Minimum starting age: 6 weeks. During the first 6 months, use minimum ages/intervals for accelerated vaccination only for travel to a polio-endemic area or an outbreak.
Conditions, related rules & sources for Inactivated polio — infant doses
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Influenza — current-season vaccination
United States · AAP/CDC infant immunization · Birth–23 months
From 6 months · every influenza season
Use an age-appropriate inactivated influenza vaccine. For 2026–2027, give two doses ≥4 weeks apart unless two prior valid influenza doses (≥4 weeks apart) were received before July 1, 2026; with that prior history, give one dose. Unknown history requires two doses.
The prior two doses need not be from the same or consecutive seasons. Live nasal vaccine is not for children under 2 years; recombinant vaccine is not an infant product.
Conditions, related rules & sources for Influenza — current-season vaccination
- Egg allergy alone does not require a different vaccine. Prior severe vaccine/component allergy, Guillain–Barré syndrome within 6 weeks of a prior influenza vaccine, and moderate/severe acute illness need the product-specific contraindication/precaution assessment.
- For two-dose recipients, start as soon as the seasonal vaccine is available to allow dose 2 ideally by the end of October; continue vaccination while influenza circulates.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
COVID conditions, precautions & sources for COVID-19 — AAP routine recommendation
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination · Conditional
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
- Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised · Catch-up
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
- After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series · Conditional
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
- One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise · Shared decision-making
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
- This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Related rule sources & dates
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months · Conditional
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
- CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Related rule sources & dates
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
Conditions, related rules & sources for MMR — first routine dose
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart · Catch-up
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
- AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization · Conditional
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
- Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
- This differs from CDC’s preference for separate injections at 12–47 months.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group · Conditional
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
- AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Related rule sources & dates
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
- A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
Conditions, related rules & sources for Varicella — first routine dose
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization · Conditional
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
- Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
- This differs from CDC’s preference for separate injections at 12–47 months.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group · Conditional
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
- AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
- Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart · Catch-up
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
- AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Related rule sources & dates
Hepatitis A — routine & catch-up series
United States · AAP/CDC infant immunization · Birth–23 months
Start at 12–23 months · second dose ≥6 months later
Give a two-dose HepA series. If one valid dose was already received at age ≥12 months, give the second ≥6 months after it; delayed series do not need restarting.
A travel dose given before 12 months does not replace this two-dose series. Depending on starting age, dose 2 can fall beyond this collection’s age window.
Conditions, related rules & sources for Hepatitis A — routine & catch-up series
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
RSV antibody — first season
United States · AAP/CDC infant immunization · Birth–23 months
Under 8 months · first RSV season
Give one dose of nirsevimab or clesrovimab if maternal RSV vaccine was not given in this pregnancy, status is unknown, or birth occurred <14 days after maternal vaccination.
For births during October–March in most of the continental US, give within one week, ideally in the birth hospitalization. For April–September births, give shortly before the season while age-eligible.
Conditions, related rules & sources for RSV antibody — first season
- If maternal vaccination was ≥14 days before birth, most infants do not need an antibody; rare exceptions are separate below. Use age on the administration date, not corrected gestational age.
- These are monoclonal antibodies, not infant vaccines. Clesrovimab is a first-season product; it is not a substitute for second-season nirsevimab. Regional public-health timing can differ.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
RSV — CDC prolonged hospitalization & rare maternal exceptions
United States · AAP/CDC infant immunization · Birth–23 months
<8 months · born during or entering the first RSV season · Conditional
CDC permits considering RSV antibody during a prolonged hospitalization shortly before or during the season, weighing risks and benefits to prevent healthcare-associated RSV.
CDC hospitalization/rare-exception context
- Despite maternal vaccine ≥14 days before birth, an infant antibody can be considered in rare cases: poor maternal immune response or transfer; bypass/ECMO/exchange transfusion causing antibody loss; or substantial infant risk such as significant heart disease or intensive-care admission with oxygen needed at discharge.
- CDC’s schedule Notes also describe dosing shortly before or promptly after discharge. These statements are retained with their source context; this app does not choose a hospital policy.
- CDC first-season eligibility: use age on the administration date. An infant under 8 months is eligible if maternal RSV vaccine was not given during pregnancy, status is unknown, or birth occurred <14 days after maternal vaccination. Except for the rare circumstances above, an antibody is not needed when maternal vaccination was ≥14 days before birth.
- Nirsevimab or clesrovimab is used for the first season. In most of the continental US, administration is October–March; newborns in that window receive it within one week, ideally during birth hospitalization. For April–September births, give shortly before the season. Follow local public-health guidance where seasonality differs.
Related rule sources & dates
RSV — AAP prolonged birth hospitalization & repeat dose
United States · AAP/CDC infant immunization · Birth–23 months
<8 months in first season · 8–19 months in second season · Conditional
After a prolonged birth hospitalization, AAP recommends RSV antibody shortly before or promptly after discharge in October–March in most of the continental US.
AAP hospitalization and repeat-dose statement
- AAP recommends a repeat dose for an age-eligible child after antibody-depleting treatments/procedures such as plasmapheresis, cardiopulmonary bypass or ECMO. Product-specific repeat-dose timing belongs to the linked prescribing information; this is not a weight/dose calculator.
- First-season eligibility (AAP): under 8 months, born during or entering the first RSV season, if maternal RSV vaccine was not given in this pregnancy, status is unknown, or birth occurred <14 days after maternal vaccination. Use one dose of nirsevimab or clesrovimab.
- If maternal vaccination was ≥14 days before birth, the antibody is usually not needed; AAP allows consideration in rare circumstances at the discretion of healthcare professionals.
- Second-season eligibility (AAP): age 8–19 months, entering the second RSV season and in an AAP high-risk group. Use nirsevimab, regardless of maternal vaccination or first-season antibody receipt; clesrovimab is a first-season product.
- AAP high-risk groups: birth before 32 weeks regardless of ongoing support; chronic lung disease from prematurity or another significant neonatal condition with steroids, diuretics or oxygen in the previous 6 months; hemodynamically significant congenital heart disease; anatomic pulmonary or neuromuscular disorders increasing RSV risk; severe immunocompromise; Down syndrome or other chromosomal differences increasing risk; qualifying cystic fibrosis; and American Indian/Alaska Native children.
- Qualifying cystic fibrosis means severe lung disease (first-year pulmonary-exacerbation hospitalization or persistent imaging changes when stable), or weight-for-length <10th percentile. This expanded AAP second-season risk list differs from CDC’s.
- Follow local public-health guidance where RSV seasonality differs. Severe previous product/component allergy contraindicates the antibody; moderate/severe acute illness is a precaution.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Delayed immunizations — do not restart
United States · AAP/CDC infant immunization · Birth–23 months
Incomplete or unknown history · birth–23 months
Give missing recommended doses at an appropriate subsequent visit. A long gap does not require restarting a vaccine series or adding doses solely because of the delay.
Apply each vaccine’s minimum ages, minimum intervals, maximum ages and product-specific rules; routine timing and minimum timing are different. Four weeks means 28 days; intervals of ≥4 months use calendar months.
More conditions & sources (1) for Delayed immunizations — do not restart
- The usual four-day grace rule applies to retrospective validation, not planned early scheduling: doses ≥5 days too early are invalid and need appropriately spaced repetition.
Source dates & verification
Preterm infants — chronological age
United States · AAP/CDC infant immunization · Birth–23 months
Stable preterm infant · chronological age
CDC recommends the usual full vaccine doses and schedule by chronological age for most clinically stable preterm infants, regardless of gestation or birth weight.
HepB birth timing is an exception. Hospitalized-infant rotavirus timing has its own recommendation; do not apply a general preterm rule to override it.
Conditions, related rules & sources for Preterm infants — chronological age
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — birth weight under 2,000 g, maternal test negative
United States · AAP/CDC infant immunization · Birth–23 months
Chronological age 1 month or discharge, whichever is earlier · Conditional
For an infant born to an HBsAg-negative mother with birth weight <2,000 g, give the first HepB dose at one month or hospital discharge, whichever comes first—even if still under 2,000 g.
- This deferral does not apply to infants of HBsAg-positive or unknown-status mothers. CDC’s perinatal table places the next single-antigen dose at 2 months and the final dose at 6–18 months, not before 24 weeks.
Related rule sources & dates
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight ≥2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Single-antigen vaccine within 12 hours of birth · Conditional
Give HepB promptly and determine maternal HBsAg status as soon as possible. If the mother is positive, give HBIG as soon as possible in a separate limb, no later than age 7 days.
- If maternal infection is otherwise evident (HBV DNA, HBeAg positivity or known chronic HBV), manage as maternal HBsAg-positive from the start.
- Final dose: age 6 months, minimum 24 weeks. If maternal status becomes positive or remains unknown, test HBsAg and anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; not before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight <2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and HBIG in separate limbs within 12 hours. Give three more vaccine doses starting at one month; the birth dose does not count toward the three-dose series.
- Do not delay immunoprophylaxis while waiting for maternal testing. Final dose: age 6 months, minimum 24 weeks.
- If maternal status becomes positive or stays unknown, test HBsAg/anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; never before 9 months.
Related rule sources & dates
Rotavirus — CDC hospitalized-infant timing
United States · AAP/CDC infant immunization · Birth–23 months
Stable, age-eligible infant · at or after NICU discharge · Conditional
CDC recommends deferring rotavirus vaccine until discharge when an infant ≥6 weeks old has remained in hospital since birth. The first dose must still be before 15 weeks, 0 days.
CDC-specific NICU timing; AAP NICU passage not yet summarized
- This is CDC’s stated NICU timing. It is not attributed to AAP’s current NICU position, which is not reproduced here without the original current Red Book passage.
- The AAP original chapter is linked in Coverage & sources; no AAP inpatient recommendation is inferred from a research article or journal blog.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Rotavirus — product-specific series
United States · AAP/CDC infant immunization · Birth–23 months
Rotarix: 2 & 4 months · RotaTeq: 2, 4 & 6 months · Routine
Give two doses of Rotarix or three doses of RotaTeq. If any prior dose was RotaTeq or the product is unknown, use a three-dose series.
- Earliest first dose: 6 weeks. Start no later than 14 weeks, 6 days; do not start at ≥15 weeks. Finish all doses by 8 months, 0 days. Minimum interval: 4 weeks.
- SCID, previous intussusception, or severe allergy to a prior dose/component are contraindications. Other immunocompromise, chronic gastrointestinal disease, moderate/severe acute illness, and RV1 with spina bifida or bladder exstrophy are precautions.
- NICU timing is body-specific; see the separate hospitalized-infant result.
Related rule sources & dates
HepB — birth weight under 2,000 g, maternal test negative
United States · AAP/CDC infant immunization · Birth–23 months
Chronological age 1 month or discharge, whichever is earlier
For an infant born to an HBsAg-negative mother with birth weight <2,000 g, give the first HepB dose at one month or hospital discharge, whichever comes first—even if still under 2,000 g.
This deferral does not apply to infants of HBsAg-positive or unknown-status mothers. CDC’s perinatal table places the next single-antigen dose at 2 months and the final dose at 6–18 months, not before 24 weeks.
Conditions, related rules & sources for HepB — birth weight under 2,000 g, maternal test negative
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight ≥2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Single-antigen vaccine within 12 hours of birth · Conditional
Give HepB promptly and determine maternal HBsAg status as soon as possible. If the mother is positive, give HBIG as soon as possible in a separate limb, no later than age 7 days.
- If maternal infection is otherwise evident (HBV DNA, HBeAg positivity or known chronic HBV), manage as maternal HBsAg-positive from the start.
- Final dose: age 6 months, minimum 24 weeks. If maternal status becomes positive or remains unknown, test HBsAg and anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; not before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight <2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and HBIG in separate limbs within 12 hours. Give three more vaccine doses starting at one month; the birth dose does not count toward the three-dose series.
- Do not delay immunoprophylaxis while waiting for maternal testing. Final dose: age 6 months, minimum 24 weeks.
- If maternal status becomes positive or stays unknown, test HBsAg/anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; never before 9 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
Conditions, related rules & sources for HepB — maternal HBsAg positive
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
HepB — maternal status unknown, birth weight ≥2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Single-antigen vaccine within 12 hours of birth
Give HepB promptly and determine maternal HBsAg status as soon as possible. If the mother is positive, give HBIG as soon as possible in a separate limb, no later than age 7 days.
If maternal infection is otherwise evident (HBV DNA, HBeAg positivity or known chronic HBV), manage as maternal HBsAg-positive from the start.
Conditions, related rules & sources for HepB — maternal status unknown, birth weight ≥2,000 g
- Final dose: age 6 months, minimum 24 weeks. If maternal status becomes positive or remains unknown, test HBsAg and anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; not before 9 months.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
HepB — maternal status unknown, birth weight <2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth
Give single-antigen HepB and HBIG in separate limbs within 12 hours. Give three more vaccine doses starting at one month; the birth dose does not count toward the three-dose series.
Do not delay immunoprophylaxis while waiting for maternal testing. Final dose: age 6 months, minimum 24 weeks.
Conditions, related rules & sources for HepB — maternal status unknown, birth weight <2,000 g
- If maternal status becomes positive or stays unknown, test HBsAg/anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; never before 9 months.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
HepB — catch-up intervals & revaccination groups
United States · AAP/CDC infant immunization · Birth–23 months
Unvaccinated: start now · 1–2 months · 6 months after start
Complete three doses with minimum intervals of 4 weeks from dose 1 to 2, and ≥8 weeks from dose 2 to final plus ≥16 weeks from dose 1 to final. The final dose must be at age ≥24 weeks.
If a four-dose combination series is used, apply final-dose requirements to dose 4.
Conditions, related rules & sources for HepB — catch-up intervals & revaccination groups
- Routine revaccination is generally unnecessary after a completed series in an immunocompetent child. Source Notes recommend post-vaccination testing and revaccination when anti-HBs is <10 mIU/mL for specific groups: infants of HBsAg-positive mothers, dialysis/predialysis patients, and other immunocompromised people. Follow their response-specific revaccination guidance; this is not a patient antibody-response calculator.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
DTaP — catch-up minimum intervals
United States · AAP/CDC infant immunization · Birth–23 months
First dose ≥6 weeks · 4 weeks · 4 weeks · 6 months
For infant catch-up, separate doses 1→2 and 2→3 by ≥4 weeks, and doses 3→4 by ≥6 months. Dose 4 must be at age ≥12 months when planned prospectively.
An inadvertently early fourth dose can be counted if age ≥12 months and ≥4 months after dose 3; this retrospective exception is not a scheduling target.
Conditions, related rules & sources for DTaP — catch-up minimum intervals
- The eventual fifth dose at 4–6 years lies beyond this collection. Do not use infant timing for older-child Tdap schedules.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
DTaP — contraindication specific to pertussis
United States · AAP/CDC infant immunization · Birth–23 months
Under age 7 years · including infants
When the pertussis component is specifically contraindicated, the Notes permit Td for the remaining recommended doses instead of DTaP.
Unexplained encephalopathy within 7 days of a prior DTP/DTaP dose is the pertussis-specific contraindication. This is not a general instruction to replace DTaP for unrelated adverse events.
Conditions, related rules & sources for DTaP — contraindication specific to pertussis
- Assess other vaccine/component allergies and neurologic precautions separately.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
DTaP — primary series & first booster
United States · AAP/CDC infant immunization · Birth–23 months
2, 4 & 6 months · booster at 15–18 months · Routine
Give the three-dose infant primary series and the first booster. The later routine booster is at 4–6 years, beyond this collection’s age scope.
- Minimum starting age: 6 weeks. Kinrix and Quadracel are not infant products (minimum age 4 years).
- For a planned early fourth dose, the child must be ≥12 months and ≥6 months beyond dose 3. Do not substitute the retrospective four-month validation interval for planned timing.
- A severe prior allergy or unexplained encephalopathy within 7 days of DTP/DTaP contraindicates DTaP. Progressive neurologic disease is a precaution until clarified/stable.
Related rule sources & dates
DTaP — catch-up minimum intervals
United States · AAP/CDC infant immunization · Birth–23 months
First dose ≥6 weeks · 4 weeks · 4 weeks · 6 months · Catch-up
For infant catch-up, separate doses 1→2 and 2→3 by ≥4 weeks, and doses 3→4 by ≥6 months. Dose 4 must be at age ≥12 months when planned prospectively.
- An inadvertently early fourth dose can be counted if age ≥12 months and ≥4 months after dose 3; this retrospective exception is not a scheduling target.
- The eventual fifth dose at 4–6 years lies beyond this collection. Do not use infant timing for older-child Tdap schedules.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — catch-up when started before 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Product and ages at earlier doses determine completion
If dose 1 was at 7–11 months, give dose 2 ≥4 weeks later, then a final dose at ≥12 months and ≥8 weeks after dose 2 (whichever is later).
If started before 7 months and still under 12 months with a PRP-T/Vaxelis/unknown product, complete primary doses 2 and 3 at ≥4-week intervals; a final dose is needed at ≥12 months and ≥8 weeks after the prior dose.
Conditions, related rules & sources for Hib — catch-up when started before 12 months
- Two PedvaxHIB doses before the first birthday need one final dose at ≥12 months and ≥8 weeks after dose 2.
- Three Hib doses before the first birthday need a final dose at ≥12 months, ≥8 weeks later. A dose already given at ≥15 months completes catch-up for a child without a separate high-risk indication.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Hib — selected high-risk conditions & therapy
United States · AAP/CDC infant immunization · Birth–23 months
12–23 months within the Notes’ 12–59-month group · Conditional
For chemotherapy/radiation, asplenia, HIV, immunoglobulin deficiency, early complement deficiency or early complement-inhibitor use: if unvaccinated or only one dose before 12 months, give two doses ≥8 weeks apart; with ≥2 earlier doses, give one ≥8 weeks after the previous dose.
- For chemotherapy/radiation, repeat doses given within 14 days before treatment or during treatment at least 3 months after treatment ends.
- For an unvaccinated child ≥15 months having elective splenectomy, one dose is recommended, preferably ≥14 days before the procedure.
Related rule sources & dates
Hib — after hematopoietic cell transplant
United States · AAP/CDC infant immunization · Birth–23 months
Start 6–12 months after successful transplant · Conditional
Give a new three-dose Hib series, with doses ≥4 weeks apart, regardless of pre-transplant Hib history.
- This is a transplant-specific schedule, not an extra series for every premature or otherwise healthy infant.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — catch-up from the first birthday
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–14 months: two doses ≥8 weeks apart
For an unvaccinated child first seen at 15–23 months, give one Hib dose. If the first dose was at 12–14 months, give one final dose ≥8 weeks later.
If dose 1 was before 12 months and dose 2 was at 12–14 months, give a final dose ≥8 weeks after dose 2.
Conditions, related rules & sources for Hib — catch-up from the first birthday
- No extra routine catch-up dose is needed after a dose at ≥15 months; separate high-risk/therapy situations can require additional vaccination. Vaxelis is not the routine booster product.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Hib — selected high-risk conditions & therapy
United States · AAP/CDC infant immunization · Birth–23 months
12–23 months within the Notes’ 12–59-month group · Conditional
For chemotherapy/radiation, asplenia, HIV, immunoglobulin deficiency, early complement deficiency or early complement-inhibitor use: if unvaccinated or only one dose before 12 months, give two doses ≥8 weeks apart; with ≥2 earlier doses, give one ≥8 weeks after the previous dose.
- For chemotherapy/radiation, repeat doses given within 14 days before treatment or during treatment at least 3 months after treatment ends.
- For an unvaccinated child ≥15 months having elective splenectomy, one dose is recommended, preferably ≥14 days before the procedure.
Related rule sources & dates
Hib — after hematopoietic cell transplant
United States · AAP/CDC infant immunization · Birth–23 months
Start 6–12 months after successful transplant · Conditional
Give a new three-dose Hib series, with doses ≥4 weeks apart, regardless of pre-transplant Hib history.
- This is a transplant-specific schedule, not an extra series for every premature or otherwise healthy infant.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — selected high-risk conditions & therapy
United States · AAP/CDC infant immunization · Birth–23 months
12–23 months within the Notes’ 12–59-month group
For chemotherapy/radiation, asplenia, HIV, immunoglobulin deficiency, early complement deficiency or early complement-inhibitor use: if unvaccinated or only one dose before 12 months, give two doses ≥8 weeks apart; with ≥2 earlier doses, give one ≥8 weeks after the previous dose.
For chemotherapy/radiation, repeat doses given within 14 days before treatment or during treatment at least 3 months after treatment ends.
Conditions, related rules & sources for Hib — selected high-risk conditions & therapy
- For an unvaccinated child ≥15 months having elective splenectomy, one dose is recommended, preferably ≥14 days before the procedure.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hib — after hematopoietic cell transplant
United States · AAP/CDC infant immunization · Birth–23 months
Start 6–12 months after successful transplant
Give a new three-dose Hib series, with doses ≥4 weeks apart, regardless of pre-transplant Hib history.
This is a transplant-specific schedule, not an extra series for every premature or otherwise healthy infant.
Conditions, related rules & sources for Hib — after hematopoietic cell transplant
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Pneumococcal conjugate — infant catch-up
United States · AAP/CDC infant immunization · Birth–23 months
Earliest dose 6 weeks · intervals depend on prior dose ages
If started at 7–11 months, give two initial doses ≥4 weeks apart and a final dose at ≥12 months and ≥8 weeks after dose 2. If first started at 12–23 months, give two doses ≥8 weeks apart.
When started before 7 months, primary intervals are ≥4 weeks; give the final infant dose at ≥12 months and ≥8 weeks after the most recent dose.
Conditions, related rules & sources for Pneumococcal conjugate — infant catch-up
- At 12–23 months with only one earlier dose given before 12 months, give two more doses ≥8 weeks apart. With two or three doses already given before 12 months, one final dose ≥8 weeks after the last completes infant catch-up.
- Additional risk-based PCV/PPSV23 pathways starting at age 2 are outside this collection. Do not use those older-child pathways to add infant PPSV23.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Polio — catch-up & recorded oral vaccine
United States · AAP/CDC infant immunization · Birth–23 months
Earliest dose 6 weeks · infant minimum intervals ≥4 weeks
For catch-up under age 4, separate IPV doses 1→2 and 2→3 by ≥4 weeks. A final dose is still required at age ≥4 years and ≥6 months after the prior dose.
In the first 6 months of life, accelerated minimum timing is for travel to a polio-endemic area or an outbreak, not routine scheduling.
Conditions, related rules & sources for Polio — catch-up & recorded oral vaccine
- Only documented trivalent OPV counts toward the US series. Doses listed as OPV on/after April 1, 2016 do not count; assess imported records rather than assuming all oral products are equivalent.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
COVID conditions, precautions & sources for COVID-19 — CDC shared decision-making
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination · Conditional
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
- Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised · Catch-up
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
- After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series · Conditional
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
- One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Related rule sources & dates
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months · Conditional
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
- CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Related rule sources & dates
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine · Routine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
- This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
COVID conditions, precautions & sources for COVID-19 — doses by prior history
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination · Conditional
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
- Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Related rule sources & dates
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine · Routine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
- This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise · Shared decision-making
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
- This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Related rule sources & dates
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months · Conditional
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
- CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Related rule sources & dates
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series · Conditional
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
- One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
COVID conditions, precautions & sources for COVID-19 — moderate/severe immunocompromise
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination · Conditional
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
- Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Related rule sources & dates
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months · Conditional
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
- CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Related rule sources & dates
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised · Catch-up
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
- After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Related rule sources & dates
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine · Routine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
- This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise · Shared decision-making
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
- This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
COVID conditions, precautions & sources for COVID-19 — product approval & off-label qualifications
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Source dates & verification
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination · Conditional
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
- Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised · Catch-up
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
- After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series · Conditional
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
- One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine · Routine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
- This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise · Shared decision-making
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
- This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
COVID-19 mRNA — contraindication & precautions
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · before mRNA COVID-19 vaccination
Contraindication: a severe allergic reaction, such as anaphylaxis, after a previous mRNA COVID-19 dose or to an mRNA vaccine component. The following conditions are precautions, not automatic contraindications.
Precaution: diagnosed nonsevere allergy to an mRNA vaccine component, such as urticaria beyond the injection site.
Precautions & sources for COVID-19 mRNA — contraindication & precautions
- Precaution: a nonsevere immediate allergic reaction beginning <4 hours after a previous mRNA COVID-19 dose.
- Precaution: myocarditis or pericarditis within 3 weeks after a dose of any COVID-19 vaccine.
- Precaution: multisystem inflammatory syndrome in children (MIS-C).
- Precaution: moderate or severe acute illness, with or without fever.
- mRNA COVID-19 vaccines contain polyethylene glycol (PEG). Original package inserts give the full ingredient lists.
- The appendices generally advise deferring vaccination for a precaution, but allow that protection benefits may outweigh adverse-reaction risk. A precaution is distinct from a contraindication; this reference does not provide individual clearance.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
COVID-19 — product approval & off-label qualifications
United States · AAP/CDC infant immunization · Birth–23 months
CDC 2026–2027 guidance · ages 6–23 months · Conditional
CDC identifies Spikevax as the only approved product for this age group, with FDA approval limited to children with at least one high-risk underlying condition. Vaccination without such a condition is off-label.
- CDC identifies more than two doses in this age group as off-label; its modified immunocompromised schedule can still recommend additional doses.
- Previous Pfizer recipients may complete with age-appropriate Moderna under CDC interchangeability guidance. The current CDC table says the 2026–2027 interchangeability guidance has not been reviewed by ACIP.
Related rule sources & dates
- CDC · Table 1a footnotes
2026–2027 COVID-19 guidance, not immunocompromised · September 23, 2026
Source checked 2026-10-27 - CDC · Table 2a footnotes
COVID-19 guidance for people who are immunocompromised · September 23, 2026; 2026–2027 season
Source checked 2026-10-27
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
COVID-19 — doses by prior history
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · not moderately/severely immunocompromised · Catch-up
Using current 2026–2027 Moderna Spikevax: an unvaccinated child receives two doses 4–8 weeks apart. After one previous Moderna dose, give one dose 4–8 weeks later.
- After one prior Pfizer dose: give two Moderna doses, first 3–8 weeks after the Pfizer dose and the next ≥4 weeks later.
- After two prior Pfizer doses: give one Moderna dose ≥8 weeks later. After a completed initial series (≥2 Moderna or ≥3 Pfizer doses), give one current-formulation Moderna dose ≥8 weeks after the last.
- AAP and CDC agree on these timing rows, but differ on recommendation category. Pfizer is no longer authorized under age 5; this is not a recommendation to give an old Pfizer product. CDC’s FDA/off-label qualifications remain separate and visible.
Related rule sources & dates
COVID-19 — moderate/severe immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · modified Moderna Spikevax series · Conditional
If unvaccinated, give three initial doses at day 0, ≥4 weeks later, and ≥4 weeks after dose 2; follow with a current-formulation dose 6 months later (minimum 2 months).
- One prior Moderna dose: two initial-series doses ≥4 weeks apart, starting ≥4 weeks after the prior dose, then the later seasonal dose. Two prior Moderna doses: one ≥4 weeks later, then the later seasonal dose.
- One prior Pfizer dose: two Moderna doses ≥4 weeks apart, starting ≥3 weeks later, then the later seasonal dose. Two prior Pfizer doses: one Moderna ≥8 weeks later, then the later seasonal dose.
- A completed three-dose initial Moderna or Pfizer series: two current-formulation Moderna doses 6 months apart (minimum 2 months), first ≥8 weeks after the last.
- The later seasonal dose described above is 6 months after completing the initial series, minimum 2 months. These are not the two-dose timing rules for an immunocompetent child. CDC identifies additional doses beyond the FDA-approved series as off-label.
Related rule sources & dates
COVID-19 — AAP routine recommendation
United States · AAP/CDC infant immunization · Birth–23 months
All children 6–23 months · 2026–2027 vaccine · Routine
AAP recommends current-formulation COVID-19 vaccination routinely for this age group. The number and spacing of Moderna Spikevax doses depend on previous vaccination and immune status.
Body-specific position: AAP routine; CDC shared decision-making
- This is a different recommendation category from CDC’s shared decision-making position for children without moderate/severe immunocompromise. The series/history and immunocompromised results below give the timing.
Related rule sources & dates
COVID-19 — CDC shared decision-making
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months without moderate/severe immunocompromise · Shared decision-making
CDC recommends deciding about 2026–2027 vaccination with parents/guardians and a healthcare professional. It emphasizes a more favorable risk–benefit balance with increased risk for severe disease.
Body-specific position: CDC shared decision-making; AAP routine
- This differs from AAP’s routine recommendation for all children 6–23 months. CDC recommends vaccination for those with moderate/severe immunocompromise; that schedule is separate.
- Prematurity is among the risk considerations described on the current CDC page. Check the source’s FDA-label versus off-label qualifications, shown in a separate result below.
Related rule sources & dates
COVID-19 — additional doses with immunocompromise
United States · AAP/CDC infant immunization · Birth–23 months
6–23 months · AAP: ≥2 months after the most recent dose · Conditional
AAP permits additional COVID-19 doses for moderate/severe immunocompromise through shared clinical decision-making, spaced at least two months after the most recent dose.
AAP-specific additional-dose statement
- This statement is specifically from AAP’s Notes. It is not grouped as an identical CDC additional-dose recommendation.
Related rule sources & dates
MMR — international travel before the first birthday
United States · AAP/CDC infant immunization · Birth–23 months
6–11 months · one dose before departure
Give an early MMR dose for international travel. Then give two valid routine doses starting at 12–15 months (12 months in high-risk areas), with the second ≥4 weeks later when using MMR.
The early dose does not count toward the two-dose routine series. AAP specifies the travel dose at least two weeks before departure; CDC Notes say before departure.
Conditions, related rules & sources for MMR — international travel before the first birthday
- If MMRV is used after the first birthday, its minimum interval is 3 months, not the four-week MMR interval. Live-vaccine contraindications still apply.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization · Conditional
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
- Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
- This differs from CDC’s preference for separate injections at 12–47 months.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group · Conditional
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
- AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
- Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
- A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart · Catch-up
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
- AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Related rule sources & dates
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
Conditions, related rules & sources for MMR — early second dose & catch-up after 12 months
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization · Conditional
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
- Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
- This differs from CDC’s preference for separate injections at 12–47 months.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group · Conditional
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
- AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
- Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
- A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
Conditions, related rules & sources for MMR + varicella — AAP first-dose product choice
- This differs from CDC’s preference for separate injections at 12–47 months.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
- Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
- A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group · Conditional
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
- AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart · Catch-up
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
- AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Related rule sources & dates
MMR + varicella — CDC first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
First dose at 12–23 months within the 12–47-month group
CDC recommends separate MMR and varicella injections for dose 1; MMRV may be used when parents/caregivers prefer it.
Body-specific first-dose product preference
AAP expresses no first-dose preference; CDC favors separate injections. MMRV’s contraindications and seizure-history precaution still apply.
Conditions, related rules & sources for MMR + varicella — CDC first-dose product choice
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
MMR — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first routine measles, mumps and rubella dose. The second routine dose is at 4–6 years; a second dose may be given earlier when indicated and properly spaced.
- Minimum routine age is 12 months. A dose at 6–11 months for travel does not replace either routine dose.
- Live MMR is contraindicated with severe immunodeficiency or severe prior vaccine/component allergy. Recent antibody-containing blood products may require a product-specific delay; assess thrombocytopenia and TB-test timing.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Varicella — first routine dose
United States · AAP/CDC infant immunization · Birth–23 months
12–15 months · Routine
Give the first varicella dose when there is no evidence of immunity. The second routine dose is at 4–6 years; when given early, space it ≥3 months after dose 1.
- A second dose inadvertently given ≥4 weeks after dose 1 can be counted; that is not the planned three-month interval.
- Live varicella is contraindicated with severe immunodeficiency, severe prior vaccine/component allergy, or unverified familial altered immunocompetence. Recent antibody-containing blood products can alter timing; see safety details.
- AAP and CDC differ on first-dose MMRV product preference; see the separately attributed results.
Related rule sources & dates
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity · Conditional
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
- For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Related rule sources & dates
MMR + varicella — AAP first-dose product choice
United States · AAP/CDC infant immunization · Birth–23 months
Toddlers receiving their first MMR/varicella immunization · Conditional
AAP expresses no preference between separate MMR plus varicella and combined MMRV for the first toddler dose.
Body-specific first-dose product preference
- Counsel about the rare possibility of a febrile seizure 1–2 weeks after a first MMRV dose. MMRV is contraindicated with HIV of any severity; a personal/family seizure history is a precaution.
- This differs from CDC’s preference for separate injections at 12–47 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MMR — early second dose & catch-up after 12 months
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · MMR doses ≥4 weeks apart · Catch-up
Complete two valid MMR doses ≥4 weeks apart for catch-up. For international travel after the first birthday, complete two doses before departure; with one prior valid dose, give the second ≥4 weeks later.
- AAP specifies completing dose 2 at least two weeks before departure for a previously unvaccinated traveler.
- If using MMRV, use its ≥3-month interval. Third-dose MMR during a mumps outbreak is a public-health-defined indication, not routine infant vaccination.
Related rule sources & dates
Live varicella/MMRV — timing precautions
United States · AAP/CDC infant immunization · Birth–23 months
Age ≥12 months · check blood products, medicines & immunity
Recent antibody-containing blood products can require a product-specific delay of up to 11 months before live MMR/varicella vaccination. Assess severe immunodeficiency and familial immune disorders before use.
For varicella/MMRV, acyclovir, famciclovir or valacyclovir within 24 hours before vaccination is a precaution; avoid those antivirals for 14 days afterward. Aspirin/salicylate use is also a precaution.
Conditions, related rules & sources for Live varicella/MMRV — timing precautions
- MMRV is contraindicated with HIV infection of any severity. MMRV also has the MMR precautions, including personal/family seizure history. Moderate/severe acute illness is a precaution for these live vaccines.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Hepatitis A — international travel
United States · AAP/CDC infant immunization · Birth–23 months
6–11 months · one travel dose before departure
For travel to countries with high or intermediate hepatitis A endemicity, give one HepA dose before departure at 6–11 months, then a new two-dose routine series from age 12 months, ≥6 months apart.
For an unvaccinated traveler age ≥12 months, start the routine series as soon as travel is considered. Do not count the pre-birthday travel dose as a routine dose.
Conditions, related rules & sources for Hepatitis A — international travel
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
RSV — CDC second-season eligibility
United States · AAP/CDC infant immunization · Birth–23 months
8–19 months · entering the second RSV season
CDC recommends one nirsevimab dose for children with chronic lung disease of prematurity needing corticosteroids, diuretics or oxygen within the preceding 6 months; severe immunocompromise; qualifying cystic fibrosis; or American Indian/Alaska Native identity.
Body-specific second-season high-risk list
Qualifying cystic fibrosis means severe lung disease (prior pulmonary-exacerbation hospitalization in the first year or persistent imaging abnormalities when stable), or weight-for-length <10th percentile.
Conditions, related rules & sources for RSV — CDC second-season eligibility
- Give shortly before or early in the season. Clesrovimab is not a second-season substitute. CDC does not recommend nirsevimab at ≥20 months or for otherwise low-risk children ≥8 months.
- AAP’s 2026 high-risk list is broader; see the AAP result rather than assuming eligibility lists are identical.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
RSV — AAP second-season eligibility
United States · AAP/CDC infant immunization · Birth–23 months
8–19 months · entering the second RSV season · Conditional
AAP recommends one nirsevimab dose for high-risk children regardless of maternal vaccination or first-season antibody receipt. Its 2026 list includes birth before 32 weeks, even without ongoing support.
AAP 2026 expanded high-risk list; differs from CDC
- Also included: chronic lung disease from prematurity or other significant neonatal conditions with steroids, diuretics or oxygen in the previous 6 months; hemodynamically significant congenital heart disease; anatomic pulmonary or neuromuscular disorders increasing RSV risk; severe immunocompromise; Down syndrome or other chromosomal differences increasing risk; qualifying cystic fibrosis; and American Indian/Alaska Native children.
- Qualifying cystic fibrosis means severe lung disease (first-year pulmonary-exacerbation hospitalization or persistent imaging changes when stable), or weight-for-length <10th percentile.
- Give shortly before the season. This expanded AAP list is not attributed to CDC; use nirsevimab, not clesrovimab, for the second season.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
RSV — AAP second-season eligibility
United States · AAP/CDC infant immunization · Birth–23 months
8–19 months · entering the second RSV season
AAP recommends one nirsevimab dose for high-risk children regardless of maternal vaccination or first-season antibody receipt. Its 2026 list includes birth before 32 weeks, even without ongoing support.
AAP 2026 expanded high-risk list; differs from CDC
Also included: chronic lung disease from prematurity or other significant neonatal conditions with steroids, diuretics or oxygen in the previous 6 months; hemodynamically significant congenital heart disease; anatomic pulmonary or neuromuscular disorders increasing RSV risk; severe immunocompromise; Down syndrome or other chromosomal differences increasing risk; qualifying cystic fibrosis; and American Indian/Alaska Native children.
Conditions, related rules & sources for RSV — AAP second-season eligibility
- Qualifying cystic fibrosis means severe lung disease (first-year pulmonary-exacerbation hospitalization or persistent imaging changes when stable), or weight-for-length <10th percentile.
- Give shortly before the season. This expanded AAP list is not attributed to CDC; use nirsevimab, not clesrovimab, for the second season.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
RSV — CDC second-season eligibility
United States · AAP/CDC infant immunization · Birth–23 months
8–19 months · entering the second RSV season · Conditional
CDC recommends one nirsevimab dose for children with chronic lung disease of prematurity needing corticosteroids, diuretics or oxygen within the preceding 6 months; severe immunocompromise; qualifying cystic fibrosis; or American Indian/Alaska Native identity.
Body-specific second-season high-risk list
- Qualifying cystic fibrosis means severe lung disease (prior pulmonary-exacerbation hospitalization in the first year or persistent imaging abnormalities when stable), or weight-for-length <10th percentile.
- Give shortly before or early in the season. Clesrovimab is not a second-season substitute. CDC does not recommend nirsevimab at ≥20 months or for otherwise low-risk children ≥8 months.
- AAP’s 2026 high-risk list is broader; see the AAP result rather than assuming eligibility lists are identical.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
RSV — CDC prolonged hospitalization & rare maternal exceptions
United States · AAP/CDC infant immunization · Birth–23 months
<8 months · born during or entering the first RSV season
CDC permits considering RSV antibody during a prolonged hospitalization shortly before or during the season, weighing risks and benefits to prevent healthcare-associated RSV.
CDC hospitalization/rare-exception context
Despite maternal vaccine ≥14 days before birth, an infant antibody can be considered in rare cases: poor maternal immune response or transfer; bypass/ECMO/exchange transfusion causing antibody loss; or substantial infant risk such as significant heart disease or intensive-care admission with oxygen needed at discharge.
Eligibility & sources for RSV — CDC prolonged hospitalization & rare maternal exceptions
- CDC’s schedule Notes also describe dosing shortly before or promptly after discharge. These statements are retained with their source context; this app does not choose a hospital policy.
- CDC first-season eligibility: use age on the administration date. An infant under 8 months is eligible if maternal RSV vaccine was not given during pregnancy, status is unknown, or birth occurred <14 days after maternal vaccination. Except for the rare circumstances above, an antibody is not needed when maternal vaccination was ≥14 days before birth.
- Nirsevimab or clesrovimab is used for the first season. In most of the continental US, administration is October–March; newborns in that window receive it within one week, ideally during birth hospitalization. For April–September births, give shortly before the season. Follow local public-health guidance where seasonality differs.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
RSV — AAP prolonged birth hospitalization & repeat dose
United States · AAP/CDC infant immunization · Birth–23 months
<8 months in first season · 8–19 months in second season
After a prolonged birth hospitalization, AAP recommends RSV antibody shortly before or promptly after discharge in October–March in most of the continental US.
AAP hospitalization and repeat-dose statement
AAP recommends a repeat dose for an age-eligible child after antibody-depleting treatments/procedures such as plasmapheresis, cardiopulmonary bypass or ECMO. Product-specific repeat-dose timing belongs to the linked prescribing information; this is not a weight/dose calculator.
Eligibility & sources for RSV — AAP prolonged birth hospitalization & repeat dose
- First-season eligibility (AAP): under 8 months, born during or entering the first RSV season, if maternal RSV vaccine was not given in this pregnancy, status is unknown, or birth occurred <14 days after maternal vaccination. Use one dose of nirsevimab or clesrovimab.
- If maternal vaccination was ≥14 days before birth, the antibody is usually not needed; AAP allows consideration in rare circumstances at the discretion of healthcare professionals.
- Second-season eligibility (AAP): age 8–19 months, entering the second RSV season and in an AAP high-risk group. Use nirsevimab, regardless of maternal vaccination or first-season antibody receipt; clesrovimab is a first-season product.
- AAP high-risk groups: birth before 32 weeks regardless of ongoing support; chronic lung disease from prematurity or another significant neonatal condition with steroids, diuretics or oxygen in the previous 6 months; hemodynamically significant congenital heart disease; anatomic pulmonary or neuromuscular disorders increasing RSV risk; severe immunocompromise; Down syndrome or other chromosomal differences increasing risk; qualifying cystic fibrosis; and American Indian/Alaska Native children.
- Qualifying cystic fibrosis means severe lung disease (first-year pulmonary-exacerbation hospitalization or persistent imaging changes when stable), or weight-for-length <10th percentile. This expanded AAP second-season risk list differs from CDC’s.
- Follow local public-health guidance where RSV seasonality differs. Severe previous product/component allergy contraindicates the antibody; moderate/severe acute illness is a precaution.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MenACWY — indicated infant Menveo series
United States · AAP/CDC infant immunization · Birth–23 months
Risk or travel indication · start at 2–23 months
If started at 2 months, give Menveo at 2, 4, 6 and 12 months. If started at 3–6 months, use 3 or 4 doses: ≥8-week intervals until a dose is given at age ≥7 months, then a final dose ≥12 weeks later and after 12 months.
If started at 7–23 months, give two doses ≥12 weeks apart, with the second after age 12 months.
Conditions, related rules & sources for MenACWY — indicated infant Menveo series
- Indications include asplenia/sickle cell disease, HIV, persistent complement deficiency or complement-inhibitor use, and travel to hyperendemic/epidemic regions (including the meningitis belt or Hajj). It is not routine for every infant.
- Use the age-appropriate lyophilized Menveo formulation, not the liquid presentation reserved for ≥10 years. Preterm birth under age 9 months is a Menveo precaution.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MenACWY — AAP infant MenQuadfi option
United States · AAP/CDC infant immunization · Birth–23 months
Minimum age 6 weeks · indication required
AAP’s September 2026 schedule allows MenQuadfi for indicated infants, using the same infant series patterns as Menveo. The first dose may be as early as 6 weeks.
AAP infant MenQuadfi option differs from current CDC schedule
AAP lists four doses when started at 2 months (then 4, 6, 12 months), 3–4 doses when started at 3–6 months using ≥8-week intervals until age ≥7 months and a final dose ≥12 weeks later after 12 months, or two doses ≥12 weeks apart when started at 7–23 months with dose 2 after 12 months.
Indications & sources for MenACWY — AAP infant MenQuadfi option
- AAP Indications: anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency or complement-inhibitor treatment; or travel to countries with hyperendemic/epidemic meningococcal disease, including the African meningitis belt or Hajj. This is not routine vaccination for every infant.
- CDC’s current child schedule still lists MenQuadfi from age 2 years. This AAP infant recommendation is not presented as a shared CDC infant recommendation.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
MenACWY — CDC schedule product limits
United States · AAP/CDC infant immunization · Birth–23 months
Menveo from 2 months · MenQuadfi from 2 years in this schedule
CDC’s current child schedule uses Menveo for indicated children under 24 months; its MenQuadfi schedule begins at age 2 years.
Current CDC schedule; not a universal product-licensure statement
A newer FDA product age approval does not, by itself, establish an identical CDC infant schedule. AAP’s 2026 MenQuadfi infant position is shown separately.
Indications, related series & sources for MenACWY — CDC schedule product limits
- CDC infant Menveo Indications: anatomic or functional asplenia (including sickle cell disease), HIV infection, persistent complement component deficiency or complement-inhibitor treatment; or travel to countries with hyperendemic/epidemic meningococcal disease, including the African meningitis belt or Hajj. This is not routine vaccination for every infant.
- For ongoing increased risk after the infant series, the first routine high-risk booster under age 7 is 3 years later, outside this collection’s age window.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
MenACWY — indicated infant Menveo series
United States · AAP/CDC infant immunization · Birth–23 months
Risk or travel indication · start at 2–23 months · Conditional
If started at 2 months, give Menveo at 2, 4, 6 and 12 months. If started at 3–6 months, use 3 or 4 doses: ≥8-week intervals until a dose is given at age ≥7 months, then a final dose ≥12 weeks later and after 12 months.
- If started at 7–23 months, give two doses ≥12 weeks apart, with the second after age 12 months.
- Indications include asplenia/sickle cell disease, HIV, persistent complement deficiency or complement-inhibitor use, and travel to hyperendemic/epidemic regions (including the meningitis belt or Hajj). It is not routine for every infant.
- Use the age-appropriate lyophilized Menveo formulation, not the liquid presentation reserved for ≥10 years. Preterm birth under age 9 months is a Menveo precaution.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Rotavirus — CDC hospitalized-infant timing
United States · AAP/CDC infant immunization · Birth–23 months
Stable, age-eligible infant · at or after NICU discharge
CDC recommends deferring rotavirus vaccine until discharge when an infant ≥6 weeks old has remained in hospital since birth. The first dose must still be before 15 weeks, 0 days.
CDC-specific NICU timing; AAP NICU passage not yet summarized
This is CDC’s stated NICU timing. It is not attributed to AAP’s current NICU position, which is not reproduced here without the original current Red Book passage.
Conditions, related rules & sources for Rotavirus — CDC hospitalized-infant timing
- The AAP original chapter is linked in Coverage & sources; no AAP inpatient recommendation is inferred from a research article or journal blog.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Rotavirus — product-specific series
United States · AAP/CDC infant immunization · Birth–23 months
Rotarix: 2 & 4 months · RotaTeq: 2, 4 & 6 months · Routine
Give two doses of Rotarix or three doses of RotaTeq. If any prior dose was RotaTeq or the product is unknown, use a three-dose series.
- Earliest first dose: 6 weeks. Start no later than 14 weeks, 6 days; do not start at ≥15 weeks. Finish all doses by 8 months, 0 days. Minimum interval: 4 weeks.
- SCID, previous intussusception, or severe allergy to a prior dose/component are contraindications. Other immunocompromise, chronic gastrointestinal disease, moderate/severe acute illness, and RV1 with spina bifida or bladder exstrophy are precautions.
- NICU timing is body-specific; see the separate hospitalized-infant result.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
HepB — CDC’s preterm wording when maternal status is unknown
United States · AAP/CDC infant immunization · Birth–23 months
CDC special-situations page: HBIG within 12 hours if preterm
CDC’s special-situations page calls for HBIG within 12 hours when maternal HBsAg status is unknown and the infant is preterm or low birth weight, alongside the birth HepB vaccine.
Within-CDC wording differs: special situations versus schedule Notes
This wording is broader than the birth-weight-only branching in CDC’s schedule Notes. It is retained as a separate CDC source-context statement; the app does not choose which institutional pathway governs a particular infant.
Conditions, related rules & sources for HepB — CDC’s preterm wording when maternal status is unknown
- For a term infant who is not low birth weight, that page permits determining maternal status up to day 7, with HBIG no later than day 7 if results are unlikely to be available. A positive result calls for HBIG as soon as possible.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
HepB — maternal status unknown, birth weight ≥2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Single-antigen vaccine within 12 hours of birth · Conditional
Give HepB promptly and determine maternal HBsAg status as soon as possible. If the mother is positive, give HBIG as soon as possible in a separate limb, no later than age 7 days.
- If maternal infection is otherwise evident (HBV DNA, HBeAg positivity or known chronic HBV), manage as maternal HBsAg-positive from the start.
- Final dose: age 6 months, minimum 24 weeks. If maternal status becomes positive or remains unknown, test HBsAg and anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; not before 9 months.
Related rule sources & dates
HepB — maternal status unknown, birth weight <2,000 g
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and HBIG in separate limbs within 12 hours. Give three more vaccine doses starting at one month; the birth dose does not count toward the three-dose series.
- Do not delay immunoprophylaxis while waiting for maternal testing. Final dose: age 6 months, minimum 24 weeks.
- If maternal status becomes positive or stays unknown, test HBsAg/anti-HBs at 9–12 months, or 1–2 months after a delayed final dose; never before 9 months.
Related rule sources & dates
HepB — maternal HBsAg positive
United States · AAP/CDC infant immunization · Birth–23 months
Vaccine + HBIG within 12 hours of birth · Conditional
Give single-antigen HepB and hepatitis B immune globulin in separate limbs within 12 hours, regardless of birth weight.
- If birth weight <2,000 g, the birth vaccine dose does not count toward the series: give three further HepB doses beginning at one month (four total). CDC’s single-antigen perinatal table places them at 1 month, 2–3 months and 6 months; for birth weight ≥2,000 g, further doses are at 1–2 months and 6 months.
- The final series dose is at 6 months and not before 24 weeks. Arrange HBsAg/anti-HBs testing at 9–12 months; for a delayed series, test 1–2 months after the final dose, never before 9 months.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit · Conditional
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
- Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Related rule sources & dates
Before vaccination — contraindications & precautions
United States · AAP/CDC infant immunization · Birth–23 months
All in-scope ages · every immunization visit
Screen for severe allergy to a previous dose or relevant component. Moderate/severe acute illness is a precaution. CDC additionally states that mild illness alone is not a contraindication or precaution.
Review the vaccine-specific risks shown with each recommendation. For DTaP, consider Guillain–Barré syndrome within 6 weeks of tetanus vaccine, Arthus-type reactions (defer tetanus/diphtheria toxoid for ≥10 years), and progressive neurologic disease.
More conditions & sources (2) for Before vaccination — contraindications & precautions
- Live MMR/varicella and rotavirus have immune-status restrictions; SCID and prior intussusception contraindicate rotavirus. Blood products, antivirals, salicylates and seizure history can change live-vaccine use.
- An appendix summary is not the complete current product insert. No patient-specific clearance, dose volume or risk calculation is produced here.
Source dates & verification
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
Conditions, related rules & sources for Low glucose: thresholds and targets
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Who needs glucose screening?
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Risk assessment at birth; symptoms or illness → test immediately
Routinely screen infants of mothers with diabetes, infants with asphyxia, preterm infants <37 weeks, and SGA infants <10th birthweight percentile. Consider LGA infants >90th percentile at risk. Do not routinely screen well, asymptomatic AGA term infants without risk factors.
Table 1 also lists IUGR, maternal labetalol, late-preterm antenatal corticosteroids, perinatal asphyxia, metabolic conditions (including carnitine palmitoyltransferase-1 deficiency, particularly in Inuit populations), and syndromes such as Beckwith–Wiedemann.
Conditions, related rules & sources for Who needs glucose screening?
- Symptoms can include tremor/jitteriness, cyanosis, seizures, apnea/tachypnea, weak or high-pitched cry, lethargy/limpness, feeding difficulty, eye-rolling, sweating, pallor or hypothermia. Test promptly; other illnesses can share these signs.
- CPS grades routine risk screening C; considering LGA infants at risk D. This is not BAPM’s narrower term-infant risk list.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
When to check and stop glucose screening
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Start at 2 h; repeat every 3–6 h with feeds · Screening
For asymptomatic at-risk infants, start at 2 h and screen before feeds, every 3–6 h. For LGA infants and infants of diabetic mothers, stop after 12 h if glucose stays ≥2.6 mmol/L. For SGA/preterm infants, stop after 24 h if feeding is established and glucose stays ≥2.6 mmol/L.
- If more than one reading is <2.6 mmol/L in the first 24 h, CPS considers one or two checks on day 2 reasonable.
- Symptoms or illness require immediate testing, rather than waiting for the screening timetable. The linked algorithm continues pre-feed or 3–6-hour monitoring after two consecutive samples reach ≥2.6 mmol/L; that is not an immediate stop rule.
- Explain the reason for blood tests and concerning symptoms to parents, so they can help with observation.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Canadian term birthweight reference
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Completed 37–42 gestational weeks · grams · Reference data
CPS Table 2 supplies sex-specific 10th and 90th percentile birthweight cut-offs for term Canadian infants. These are reference data, not a universal growth chart or a calculated patient classification.
- CPS attributes this reference to Kramer et al. (2001). Values are reproduced as published, not newly estimated or applied to an entered patient.
- CPS risk criteria use <10th percentile for SGA and >90th for LGA. The table does not cover preterm gestations or every population.
Related rule sources & dates
- CPS · Table 2; Infants at risk
Screening and management of newborns at risk for low blood glucose · Posted November 20, 2019; updated March 28, 2025
Source checked 2026-10-27
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
When to check and stop glucose screening
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Start at 2 h; repeat every 3–6 h with feeds
For asymptomatic at-risk infants, start at 2 h and screen before feeds, every 3–6 h. For LGA infants and infants of diabetic mothers, stop after 12 h if glucose stays ≥2.6 mmol/L. For SGA/preterm infants, stop after 24 h if feeding is established and glucose stays ≥2.6 mmol/L.
If more than one reading is <2.6 mmol/L in the first 24 h, CPS considers one or two checks on day 2 reasonable.
Conditions, related rules & sources for When to check and stop glucose screening
- Symptoms or illness require immediate testing, rather than waiting for the screening timetable. The linked algorithm continues pre-feed or 3–6-hour monitoring after two consecutive samples reach ≥2.6 mmol/L; that is not an immediate stop rule.
- Explain the reason for blood tests and concerning symptoms to parents, so they can help with observation.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Who needs glucose screening?
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Risk assessment at birth; symptoms or illness → test immediately · Screening
Routinely screen infants of mothers with diabetes, infants with asphyxia, preterm infants <37 weeks, and SGA infants <10th birthweight percentile. Consider LGA infants >90th percentile at risk. Do not routinely screen well, asymptomatic AGA term infants without risk factors.
- Table 1 also lists IUGR, maternal labetalol, late-preterm antenatal corticosteroids, perinatal asphyxia, metabolic conditions (including carnitine palmitoyltransferase-1 deficiency, particularly in Inuit populations), and syndromes such as Beckwith–Wiedemann.
- Symptoms can include tremor/jitteriness, cyanosis, seizures, apnea/tachypnea, weak or high-pitched cry, lethargy/limpness, feeding difficulty, eye-rolling, sweating, pallor or hypothermia. Test promptly; other illnesses can share these signs.
- CPS grades routine risk screening C; considering LGA infants at risk D. This is not BAPM’s narrower term-infant risk list.
Related rule sources & dates
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Canadian term birthweight reference
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Completed 37–42 gestational weeks · grams · Reference data
CPS Table 2 supplies sex-specific 10th and 90th percentile birthweight cut-offs for term Canadian infants. These are reference data, not a universal growth chart or a calculated patient classification.
- CPS attributes this reference to Kramer et al. (2001). Values are reproduced as published, not newly estimated or applied to an entered patient.
- CPS risk criteria use <10th percentile for SGA and >90th for LGA. The table does not cover preterm gestations or every population.
Related rule sources & dates
- CPS · Table 2; Infants at risk
Screening and management of newborns at risk for low blood glucose · Posted November 20, 2019; updated March 28, 2025
Source checked 2026-10-27
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
Conditions, related rules & sources for Low glucose: feeding, recheck and IV escalation
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
Conditions, related rules & sources for Dextrose gel with feeding
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
Conditions, related rules & sources for IV glucose: initial reference and monitoring
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
Conditions, related rules & sources for Persistent hypoglycemia: critical sample
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
More conditions & sources (1) for Persistent hypoglycemia: before discharge
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Source dates & verification
Glucose measurement: low-range reliability
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Screening versus laboratory-confirmed persistent diagnosis
Use quality-controlled glucose methods reliable in the 1–3 mmol/L range. Many point-of-care methods are less reliable at low levels; confirm a persistent diagnosis by laboratory testing while avoiding delay in acute treatment.
Interpret the sample type, processing delay and method: capillary/venous, whole-blood/plasma results can differ. Avoid assuming these values are interchangeable.
More conditions & sources (1) for Glucose measurement: low-range reliability
- No single glucose number ensures safety in every infant. Symptoms, gestation, size, prior episodes, etiology and energy availability change the clinical context.
Source dates & verification
Canadian term birthweight reference
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Completed 37–42 gestational weeks · grams
CPS Table 2 supplies sex-specific 10th and 90th percentile birthweight cut-offs for term Canadian infants. These are reference data, not a universal growth chart or a calculated patient classification.
CPS risk criteria use <10th percentile for SGA and >90th for LGA. The table does not cover preterm gestations or every population.
- CPS attributes this reference to Kramer et al. (2001). Values are reproduced as published, not newly estimated or applied to an entered patient.
Conditions, related rules & sources for Canadian term birthweight reference
Source dates & verification
- CPS · Table 2; Infants at risk
Screening and management of newborns at risk for low blood glucose · Posted November 20, 2019; updated March 28, 2025
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Who needs glucose screening?
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Risk assessment at birth; symptoms or illness → test immediately · Screening
Routinely screen infants of mothers with diabetes, infants with asphyxia, preterm infants <37 weeks, and SGA infants <10th birthweight percentile. Consider LGA infants >90th percentile at risk. Do not routinely screen well, asymptomatic AGA term infants without risk factors.
- Table 1 also lists IUGR, maternal labetalol, late-preterm antenatal corticosteroids, perinatal asphyxia, metabolic conditions (including carnitine palmitoyltransferase-1 deficiency, particularly in Inuit populations), and syndromes such as Beckwith–Wiedemann.
- Symptoms can include tremor/jitteriness, cyanosis, seizures, apnea/tachypnea, weak or high-pitched cry, lethargy/limpness, feeding difficulty, eye-rolling, sweating, pallor or hypothermia. Test promptly; other illnesses can share these signs.
- CPS grades routine risk screening C; considering LGA infants at risk D. This is not BAPM’s narrower term-infant risk list.
Related rule sources & dates
When to check and stop glucose screening
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Start at 2 h; repeat every 3–6 h with feeds · Screening
For asymptomatic at-risk infants, start at 2 h and screen before feeds, every 3–6 h. For LGA infants and infants of diabetic mothers, stop after 12 h if glucose stays ≥2.6 mmol/L. For SGA/preterm infants, stop after 24 h if feeding is established and glucose stays ≥2.6 mmol/L.
- If more than one reading is <2.6 mmol/L in the first 24 h, CPS considers one or two checks on day 2 reasonable.
- Symptoms or illness require immediate testing, rather than waiting for the screening timetable. The linked algorithm continues pre-feed or 3–6-hour monitoring after two consecutive samples reach ≥2.6 mmol/L; that is not an immediate stop rule.
- Explain the reason for blood tests and concerning symptoms to parents, so they can help with observation.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Dextrose infusion: published GIR reference
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Static CPS Table 4 · no patient entry or calculations
Read the published relationship between total fluid intake, dextrose concentration and glucose infusion rate. CPS flags GIR >10 mg/kg/min for further investigation; the narrative starting IV reference is D10 at 80 mL/kg/day.
All cells below retain CPS’s printed values and rounding; hourly rates and GIR values have not been recalculated. These are reference relationships, not recommended fluid volumes for every newborn.
- D = dextrose concentration (%); GIR = glucose infusion rate (mg/kg/min); TFI = total fluid intake.
- CPS: GIR >10 mg/kg/min should prompt further investigation. Wider tables scroll horizontally inside this card.
Conditions, related rules & sources for Dextrose infusion: published GIR reference
- CPS’s legend describes light-grey cells as typical starts and darker cells as GIR >10 requiring investigation. The web table does not retain those cell colours; the clinical meaning is stated in text instead.
- The transitional supplemented-infant oral-plus-IV intake caution, electrolyte monitoring, symptomatic treatment, and investigation thresholds remain in the local related rules.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
IV glucose: initial reference and monitoring
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Immediate for symptomatic hypoglycemia; recheck 30 min · Management
When IV therapy is needed, CPS describes D10 at 80 mL/kg/day (5.5 mg/kg/min). Recheck response after 30 min and after each increase. Persistent failure to meet targets or a requirement >10 mg/kg/min warrants investigation and specialist referral.
- The narrative says a 2 mL/kg D10 bolus may hasten steady state, but benefit for asymptomatic infants is unclear. The linked algorithm specifies that bolus over 15 min for symptomatic infants, alongside an infusion.
- The algorithm’s IV branch gives targets 2.6–5.0 mmol/L at <72 h and 3.3–5.0 at ≥72 h; increase D10 by 1 mL/kg/h every 30 min while checking every 30 min until target, and check electrolytes in 8–12 h. These are static published references, not an infusion calculator.
- For supplemented infants during transition, the narrative cautions against total oral plus IV intake >100 mL/kg/day because of overhydration/hyponatremia; monitor electrolytes. Its >2.6 target wording differs from ≥2.6 in final Recommendations/algorithm.
- Narrative: IV dextrose can be weaned after glucose is stable for 12 h. Algorithm: monitor every 3 h, introduce/titrate feeds as tolerated and wean IV stepwise; continue pre-feed checks until full enteral feeds and two consecutive normal samples.
- Algorithm: consider central access/level-3 care at GIR >8–10 mg/kg/min; medication at >10–12; investigate if >10–12 and age >72 h. Up to D20 may be given peripherally while central access is obtained. Narrative also permits peripheral D20 rather than assuming ≥15% requires central access.
- Glucagon is discussed for refractory cases (IV bolus 0.1–0.3 mg/kg or infusion 10–30 micrograms/kg/h). Evidence for initial hydrocortisone, diazoxide or octreotide is limited; etiology-specific treatment requires specialist input.
- CPS notes that glucose boluses act briefly; after one or two boluses, increase the infusion rate or dextrose concentration rather than relying on repeated boluses alone.
Related rule sources & dates
Low glucose: thresholds and targets
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h versus ≥72 h · Thresholds
During the first 72 h, intervene for one glucose <2.6 mmol/L in an at-risk infant after one effective feed. Symptomatic hypoglycemia requires immediate treatment. Persistent hypoglycemia has a higher treatment target, ≥3.3 mmol/L.
CPS thresholds are body-specific; BAPM and ABM use different scopes and operational values.
- Values reproduce Table 3; the narrative specifies goals ≥2.6 and ≥3.3.
- *At ≥72 h, send a critical sample to determine cause and confirm laboratory glucose. Investigate earlier if an endocrine/metabolic disorder is suspected. At that boundary, detailed CPS text uses <2.8 mmol/L; its final Recommendations says ≤2.8. The app does not resolve the difference.
- The table separates a treatment goal from an investigation threshold; they are not interchangeable. Early suspected endocrine/metabolic disease can justify investigation before 72 h.
- Persistent critical-sample wording differs within CPS: detailed text uses point-of-care <2.8 mmol/L; final Recommendations uses ≤2.8 mmol/L. That boundary is unresolved here. A critical sample includes laboratory glucose confirmation.
- For documented hyperinsulinism the narrative notes a target ≥3.3 mmol/L, including during transition; this is not the usual transitional target.
Related rule sources & dates
Persistent hypoglycemia: critical sample
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Beyond 72 h; earlier if endocrine/metabolic disease suspected · Investigation
Investigate hypoglycemia persisting beyond 72 h and aim for glucose ≥3.3 mmol/L. CPS’s detailed section calls for a critical sample when point-of-care glucose is <2.8 mmol/L; its final Recommendations says ≤2.8 mmol/L. Preserve that unresolved boundary difference.
Within CPS: <2.8 versus ≤2.8 mmol/L for persistent investigation. No precedence is inferred.
- Confirm plasma glucose; obtain beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine and acylcarnitine profile. Plan further evaluation with endocrine/metabolic specialists.
- Point-of-care and laboratory glucose can differ by up to 20%; a persistent diagnosis requires laboratory confirmation. Acute treatment may start from a point-of-care result to avoid delay.
- Investigation is usually deferred until 72 h unless an endocrine/metabolic disorder is suspected earlier. The initial 72-h hypoglycemia period does not automatically require a full investigation panel.
- A laboratory-confirmed glucose <3.3 mmol/L beyond transition indicates persistent hypoglycemia warranting assessment; the treatment target and critical-sample trigger serve different purposes.
Related rule sources & dates
Low glucose: feeding, recheck and IV escalation
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
First 72 h · distinguish symptoms and feeding tolerance · Management
For an asymptomatic infant at 1.8–2.5 mmol/L, supplement enterally and recheck in 30 min. Symptoms with glucose <2.6 mmol/L need immediate IV treatment and concurrent investigation. Failed feeding intervention or inability to feed requires IV glucose; very low glucose, especially <1.8 mmol/L, requires expedient IV therapy.
- An at-risk infant with one reading <2.6 mmol/L after one effective feed requires intervention. Do not wait for repeat low readings in a symptomatic infant.
- Encourage frequent breastfeeding; milk supplementation/feeding support should be tailored to size, age and gestation. The supplement lists mother’s expressed milk, donor milk, then formula as preference order.
- The linked algorithm starts with gel 0.5 mL/kg of 40% plus breastfeeding OR milk 5 mL/kg plus breastfeeding; recheck 30 min after feed. If tolerating feeds and glucose ≥1.8 but still below the applicable threshold, it specifies gel AND 5 mL/kg plus breastfeeding OR milk 8 mL/kg plus breastfeeding; recheck 30 min.
- If feeds are not tolerated or glucose remains below threshold after that step, the algorithm escalates to IV. Its threshold is 3.3 mmol/L after 72 h or with known congenital hypoglycemia/hyperinsulinism or GIR >10–12 mg/kg/min; do not apply the 2.6 transitional branch indiscriminately.
- CPS also suggests considering delayed first bath and, when IV access is difficult, slow milk feeding by pump rather than a bolus. Frequent on-demand breastfeeding is encouraged.
Related rule sources & dates
Persistent hypoglycemia: before discharge
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Supervised 5–6 h fast before discharge · Discharge & follow-up
For persistent hypoglycemia, CPS recommends a 5–6 h fast with glucose maintained ≥3.3 mmol/L before discharge; document levels at 4 and 5 h after feeding.
- Establish the underlying cause and specific treatment before discharge. Prepare parents for feeding frequency, any home glucose monitoring, medication and other required care.
- This is a supervised inpatient safety assessment for persistent hypoglycemia, not advice to withhold feeds at home or a discharge-clearance tool.
Related rule sources & dates
Dextrose gel with feeding
At-risk newborns, including preterm infants; transitional first 72 h and persistent hypoglycemia are distinct.
Asymptomatic glucose <2.6 mmol/L; symptoms → bridge only · Management
CPS permits 40% buccal dextrose gel, 0.5 mL/kg (200 mg/kg), with enteral supplementation as an alternative to IV therapy in asymptomatic hypoglycemia. With symptoms, gel is only a temporary measure while IV access and treatment are established.
- Give gel with a breastfeed or measured expressed milk, donor milk, or formula. The linked algorithm’s oral branches require a 30-min post-feed glucose check and escalate for nonresponse or feeding intolerance.
- Do not use gel to delay IV treatment in a symptomatic/unwell infant or one with very low glucose, particularly <1.8 mmol/L.
- CPS discusses up to two doses in the Sugar Babies trial; that trial definition is not presented here as a universal maximum-dose protocol.
Related rule sources & dates
ABM glucose screening risks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Term/late-preterm protocol; risk list includes NICU admission
Screen at-risk infants and infants with compatible symptoms. Table 2 includes maternal diabetes or abnormal glucose-tolerance testing (especially poorly controlled), hypertension/pre-eclampsia, previous macrosomic infant, substance exposure, beta-agonist tocolytics, oral hypoglycemics, and late antepartum/intrapartum IV glucose.
Neonatal risks: IUGR/wasting, birthweight <2,500 g, SGA <10th percentile, LGA >90th with macrosomic appearance, discordant twin (10% smaller), poorly controlled maternal diabetes, prematurity (<35 weeks or late-preterm with signs/extremely poor feeding), perinatal stress/acidosis/hypoxia, cold stress.
Conditions, related rules & sources for ABM glucose screening risks
- Also: venous hematocrit >70%/hyperviscosity, erythroblastosis fetalis, Beckwith–Wiedemann, microphallus/midline defects, suspected infection, respiratory distress, suspected metabolic/endocrine disorder, any NICU admission, or compatible signs.
- Table 2 notes <10th percentile as US/WHO SGA definition versus British <2nd, and LGA can indicate undiagnosed maternal diabetes in unscreened populations. These notes are not current independent WHO/BAPM endorsements.
- Appendix A2 (≥35 weeks) abbreviates risks differently: all <37-week infants, LGA with limited prenatal care, NICU admission and other listed risks. The wider Table 2 list must not extend this algorithm to <35 weeks.
- Table 1/Appendix A2 signs include irritability, tremor/jitteriness, tachypnea, sweating/pallor, temperature instability, tachycardia, poor feeding/vomiting, lethargy/hypotonia, seizures, apnea/cyanosis/bradycardia, coma or circulatory collapse. Signs require immediate glucose assessment, not a scheduled-screen delay.
Source dates & verification
- ABM · Table 2; p6 General B; p11 Appendix A2
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM: first checks and screening duration
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Suspected hyperinsulinism: narrative within 60 min; appendix within 90 min · Screening
ABM’s General B recommends checking within 60 min for suspected significant hyperinsulinism (poorly controlled maternal diabetes or known genetic hyperinsulinism). For other risks, check before the second feed or at 2–4 h. Continue until at least three satisfactory pre-feed measurements; narrative goal ≥45 mg/dL (2.5 mmol/L).
ABM narrative and appendix differ on the initial hyperinsulinism check time and some target/investigation wording.
- Restart checks if energy intake falls. Monitor late-preterm, SGA and clinically growth-restricted infants for 24 h, with decreasing frequency. Symptoms require immediate glucose testing.
- Nonenzymatic bedside screening results require formal laboratory confirmation, but treat symptomatic infants immediately. Enzymatic point-of-care devices such as blood-gas analyzers do not require that confirmation under ABM.
- ABM Appendix A2 instead says within 90 min regardless of feeding for a hyperinsulinism history, and uses a >54 mg/dL (3.0 mmol/L) target in its >45 branch. These within-source differences are preserved; the app does not decide which takes precedence.
Related rule sources & dates
- ABM · General B1–6; Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM: first checks and screening duration
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Suspected hyperinsulinism: narrative within 60 min; appendix within 90 min
ABM’s General B recommends checking within 60 min for suspected significant hyperinsulinism (poorly controlled maternal diabetes or known genetic hyperinsulinism). For other risks, check before the second feed or at 2–4 h. Continue until at least three satisfactory pre-feed measurements; narrative goal ≥45 mg/dL (2.5 mmol/L).
ABM narrative and appendix differ on the initial hyperinsulinism check time and some target/investigation wording.
Restart checks if energy intake falls. Monitor late-preterm, SGA and clinically growth-restricted infants for 24 h, with decreasing frequency. Symptoms require immediate glucose testing.
Conditions, related rules & sources for ABM: first checks and screening duration
- Nonenzymatic bedside screening results require formal laboratory confirmation, but treat symptomatic infants immediately. Enzymatic point-of-care devices such as blood-gas analyzers do not require that confirmation under ABM.
- ABM Appendix A2 instead says within 90 min regardless of feeding for a hyperinsulinism history, and uses a >54 mg/dL (3.0 mmol/L) target in its >45 branch. These within-source differences are preserved; the app does not decide which takes precedence.
Source dates & verification
- ABM · General B1–6; Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM: feeding and thermal support
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Stable infants · ideally breastfeed within 30–60 min
Start breastfeeding early in stable infants, maintain safe skin-to-skin warmth, and feed to cues. At-risk infants should still be offered feeds during the early 6–8 h sleep period. Healthy term infants do not need routine water, glucose-water or formula supplementation.
For documented asymptomatic low glucose, ABM describes frequent breastfeeds/any colostrum plus substitute milk as needed: 2–10 mL/feed in the first 24 h, 5–15 mL/feed at 24–48 h (pasteurized donor milk or formula). Glucose water is unsuitable.
Conditions, related rules & sources for ABM: feeding and thermal support
- The narrative asymptomatic branch is described as >20–25 but <35–45 mg/dL (1.1–1.4 to 2.0–2.5 mmol/L); those printed ranges are not one universal threshold.
- If a symptom-free infant is ready to feed and a staff glucose check is delayed, do not delay breastfeeding merely to obtain a pre-feed test. Failure to respond, inability to suck or feed intolerance requires IV therapy and assessment, not forced feeding.
Source dates & verification
- ABM · General A; Management A1–7 p6
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM: buccal gel and reassessment
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
40% dextrose · 0.5 mL/kg (200 mg/kg) with feeding · Management
For low/borderline glucose in the asymptomatic feeding branch, ABM recommends buccal 40% dextrose gel with a feeding plan, preferably breastfeeding. Check glucose before the next feed; a single repeat dose appears safe.
- Recheck before subsequent feeds until acceptable/stable (narrative usually >45 mg/dL or ≥2.5 mmol/L). If glucose remains low despite feeds, use IV glucose.
- With clinical signs, gel is only a bridge if IV access is delayed, not a substitute for IV therapy.
- Appendix A2 uses narrower recheck bands: 25–34 mg/dL → ½–1 h; 35–45 without signs → 1–2 h; IV branch → within 30 min. Its detailed follow-up actions are retained in the local algorithm reference.
Related rule sources & dates
- ABM · Management A3–7, B7; Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
ABM: symptomatic or severe low glucose
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Abnormal signs or glucose <20–25 mg/dL (<1.1–1.4 mmol/L) · Management
ABM directs IV treatment for abnormal signs or very low glucose. It describes D10 bolus 1–2 mL/kg and infusion 5–8 mg/kg/min; symptomatic narrative target is >45 mg/dL (>2.5 mmol/L). Do not force feeds in an infant unable to suck or tolerate feeds.
- Assess underlying illness, particularly after earlier good feeding. Continue breastfeeding/oral feeds during IV therapy if interested and able; gradually wean IV as glucose normalizes and feeds increase. Check before feeds until stable off IV.
- Appendix A2 specifically places <20–25 mg/dL OR <45 with serious signs (apnea, seizures, impaired consciousness) in its IV branch, with target 45–54 mg/dL (2.5–3.0 mmol/L) and recheck within 30 min. The narrative also cites <1.0 mmol/L from BAPM; that citation is not a substitute for the current BAPM framework.
- Document examination, screening/lab results, treatment and response. Severe hypoglycemia with seizures, impaired consciousness or circulatory collapse calls for MRI and long-term follow-up.
Related rule sources & dates
- ABM · Management B1–8 (p6–7); Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM: persistent low glucose and discharge
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Narrative: urgent investigation >48 h, or severe at any time · Discharge & follow-up
ABM recommends urgent investigation if hypoglycemia persists beyond 48 h or is severe at any time. For persistent hypoglycemia >4 days or any IV-treated hypoglycemia, the management narrative requires >70 mg/dL (3.9 mmol/L) through several fast–feed cycles before discharge.
ABM narrative: >48 h investigation; appendix: >72 h. Its two discharge passages also specify different populations and glucose targets.
- General B separately reports PES’s severe-persistent safety-fast recommendation: 6–8 h maintaining pre-feed >60 mg/dL (3.3 mmol/L). This is ABM’s quotation of PES, not an independently verified current PES recommendation or the same criterion as ABM Management A9.
- Appendix A2 instead calls for investigation with persistence >72 h or a severe glucose requirement >10–12 mg/kg/min. These differences in time/targets remain explicit; none gives individualized discharge clearance.
Related rule sources & dates
ABM: buccal gel and reassessment
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
40% dextrose · 0.5 mL/kg (200 mg/kg) with feeding
For low/borderline glucose in the asymptomatic feeding branch, ABM recommends buccal 40% dextrose gel with a feeding plan, preferably breastfeeding. Check glucose before the next feed; a single repeat dose appears safe.
Recheck before subsequent feeds until acceptable/stable (narrative usually >45 mg/dL or ≥2.5 mmol/L). If glucose remains low despite feeds, use IV glucose.
Conditions, related rules & sources for ABM: buccal gel and reassessment
- With clinical signs, gel is only a bridge if IV access is delayed, not a substitute for IV therapy.
- Appendix A2 uses narrower recheck bands: 25–34 mg/dL → ½–1 h; 35–45 without signs → 1–2 h; IV branch → within 30 min. Its detailed follow-up actions are retained in the local algorithm reference.
Source dates & verification
- ABM · Management A3–7, B7; Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM: symptomatic or severe low glucose
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Abnormal signs or glucose <20–25 mg/dL (<1.1–1.4 mmol/L) · Management
ABM directs IV treatment for abnormal signs or very low glucose. It describes D10 bolus 1–2 mL/kg and infusion 5–8 mg/kg/min; symptomatic narrative target is >45 mg/dL (>2.5 mmol/L). Do not force feeds in an infant unable to suck or tolerate feeds.
- Assess underlying illness, particularly after earlier good feeding. Continue breastfeeding/oral feeds during IV therapy if interested and able; gradually wean IV as glucose normalizes and feeds increase. Check before feeds until stable off IV.
- Appendix A2 specifically places <20–25 mg/dL OR <45 with serious signs (apnea, seizures, impaired consciousness) in its IV branch, with target 45–54 mg/dL (2.5–3.0 mmol/L) and recheck within 30 min. The narrative also cites <1.0 mmol/L from BAPM; that citation is not a substitute for the current BAPM framework.
- Document examination, screening/lab results, treatment and response. Severe hypoglycemia with seizures, impaired consciousness or circulatory collapse calls for MRI and long-term follow-up.
Related rule sources & dates
- ABM · Management B1–8 (p6–7); Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
ABM: persistent low glucose and discharge
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Narrative: urgent investigation >48 h, or severe at any time · Discharge & follow-up
ABM recommends urgent investigation if hypoglycemia persists beyond 48 h or is severe at any time. For persistent hypoglycemia >4 days or any IV-treated hypoglycemia, the management narrative requires >70 mg/dL (3.9 mmol/L) through several fast–feed cycles before discharge.
ABM narrative: >48 h investigation; appendix: >72 h. Its two discharge passages also specify different populations and glucose targets.
- General B separately reports PES’s severe-persistent safety-fast recommendation: 6–8 h maintaining pre-feed >60 mg/dL (3.3 mmol/L). This is ABM’s quotation of PES, not an independently verified current PES recommendation or the same criterion as ABM Management A9.
- Appendix A2 instead calls for investigation with persistence >72 h or a severe glucose requirement >10–12 mg/kg/min. These differences in time/targets remain explicit; none gives individualized discharge clearance.
Related rule sources & dates
ABM: symptomatic or severe low glucose
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Abnormal signs or glucose <20–25 mg/dL (<1.1–1.4 mmol/L)
ABM directs IV treatment for abnormal signs or very low glucose. It describes D10 bolus 1–2 mL/kg and infusion 5–8 mg/kg/min; symptomatic narrative target is >45 mg/dL (>2.5 mmol/L). Do not force feeds in an infant unable to suck or tolerate feeds.
Assess underlying illness, particularly after earlier good feeding. Continue breastfeeding/oral feeds during IV therapy if interested and able; gradually wean IV as glucose normalizes and feeds increase. Check before feeds until stable off IV.
Conditions, related rules & sources for ABM: symptomatic or severe low glucose
- Appendix A2 specifically places <20–25 mg/dL OR <45 with serious signs (apnea, seizures, impaired consciousness) in its IV branch, with target 45–54 mg/dL (2.5–3.0 mmol/L) and recheck within 30 min. The narrative also cites <1.0 mmol/L from BAPM; that citation is not a substitute for the current BAPM framework.
- Document examination, screening/lab results, treatment and response. Severe hypoglycemia with seizures, impaired consciousness or circulatory collapse calls for MRI and long-term follow-up.
Source dates & verification
- ABM · Management B1–8 (p6–7); Appendix A2 p11
Clinical Protocol #1: glucose monitoring and treatment of hypoglycemia in term and late-preterm neonates · Revised 2021; current revision listed by ABM on October 27, 2026
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM: persistent low glucose and discharge
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Narrative: urgent investigation >48 h, or severe at any time · Discharge & follow-up
ABM recommends urgent investigation if hypoglycemia persists beyond 48 h or is severe at any time. For persistent hypoglycemia >4 days or any IV-treated hypoglycemia, the management narrative requires >70 mg/dL (3.9 mmol/L) through several fast–feed cycles before discharge.
ABM narrative: >48 h investigation; appendix: >72 h. Its two discharge passages also specify different populations and glucose targets.
- General B separately reports PES’s severe-persistent safety-fast recommendation: 6–8 h maintaining pre-feed >60 mg/dL (3.3 mmol/L). This is ABM’s quotation of PES, not an independently verified current PES recommendation or the same criterion as ABM Management A9.
- Appendix A2 instead calls for investigation with persistence >72 h or a severe glucose requirement >10–12 mg/kg/min. These differences in time/targets remain explicit; none gives individualized discharge clearance.
Related rule sources & dates
ABM: persistent low glucose and discharge
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Narrative: urgent investigation >48 h, or severe at any time
ABM recommends urgent investigation if hypoglycemia persists beyond 48 h or is severe at any time. For persistent hypoglycemia >4 days or any IV-treated hypoglycemia, the management narrative requires >70 mg/dL (3.9 mmol/L) through several fast–feed cycles before discharge.
ABM narrative: >48 h investigation; appendix: >72 h. Its two discharge passages also specify different populations and glucose targets.
General B separately reports PES’s severe-persistent safety-fast recommendation: 6–8 h maintaining pre-feed >60 mg/dL (3.3 mmol/L). This is ABM’s quotation of PES, not an independently verified current PES recommendation or the same criterion as ABM Management A9.
Conditions, related rules & sources for ABM: persistent low glucose and discharge
- Appendix A2 instead calls for investigation with persistence >72 h or a severe glucose requirement >10–12 mg/kg/min. These differences in time/targets remain explicit; none gives individualized discharge clearance.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L · Reference data
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
- For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Related rule sources & dates
ABM appendix: glucose bands and rechecks
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Appendix A2 · gestation ≥35 weeks · published mg/dL and mmol/L
ABM’s appendix gives band-specific feeding/IV actions and recheck intervals. Its timing and targets differ from parts of the narrative; read both locally rather than treating the appendix as a universal consensus rule.
Narrative/appendix differences remain unresolved and visibly attributed to ABM.
For suspected hyperinsulinism: appendix first check within 90 min regardless of feeds; General B1a says within 60 min. Other risks: before second feed/2–4 h. Symptoms: immediate.
- Source values, units and approximations are retained without recalculation. This appendix is adapted from the Swedish 2020 guideline; it is attributed here to ABM’s published appendix, not a separately checked Swedish recommendation.
- Appendix population ≥35 weeks. Do not extend to very-preterm infants. See the locally stated narrative differences.
More conditions & sources (3) for ABM appendix: glucose bands and rechecks
- General B2 narrative goal is ≥45 mg/dL; Management B3 symptomatic goal >45; appendix IV goal 45–54 and >45 branch goal >54. General B3 investigates >48 h or severe anytime; appendix says >72 h or >10–12 mg/kg/min requirement. These are unresolved within-source differences, not interchangeable targets.
- At 25–34, if <25 at next check, a single repeat gel may be used and IV considered; increase IV if already receiving it. At 35–45 without signs, if <35 at next check, a single repeat gel may be used and IV considered; if still 35–45, refeed.
- Appendix identifies early milk support within 1 h, gel 400 mg/mL at 0.5 mL/kg massaged into dried buccal mucosa. Oral feeding is only for infants able to tolerate it; symptomatic/severe cases need IV.
Source dates & verification
ABM: protect feeding and support families
Term/late-preterm, breastfeeding-focused protocol; Appendix A2 is restricted to gestation ≥35 weeks. Not a protocol for very-preterm intensive care.
Throughout glucose monitoring and treatment
Explain the reason for extra support and blood tests verbally and in writing. Teach hand expression, give available colostrum, and support expression ideally eight times per 24 h until feeding is effective. Reassure families that hypoglycemia does not mean their milk is inadequate.
Return to breastfeeding promptly when possible; use expert, consistent lactation support and safe skin-to-skin care. Consider delaying/omitting the bath unless medically indicated.
More conditions & sources (2) for ABM: protect feeding and support families
- ABM suggests considering antenatal/perinatal expression for gestational diabetes; this is a general professional-care recommendation, not a patient-specific pregnancy instruction.
- Parent appendix advises early feeds within 30–60 min, at least every 3 h for higher-risk infants, warmth and keeping the dyad together when feasible. It describes maternal diabetes control as a prevention measure. Parent education is not an independent new clinical threshold set.
Source dates & verification
BAPM: term-infant screening risks
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term ≥37 weeks · birth–72 h
Monitor term infants with fetal growth restriction/clinical wasting, maternal diabetes, or maternal beta-blocker exposure in the third trimester or at birth. BAPM does not recommend routine screening for LGA alone without maternal diabetes or Beckwith–Wiedemann features.
BAPM’s LGA and growth-percentile risk criteria differ from CPS/ABM; BAPM itself uses <2nd versus ≤2nd in different sections.
Practice Point 1 and Flowchart A use birthweight <2nd centile or clinical wasting; supporting text p14 uses ≤2nd. That exact-boundary difference is unresolved. Clinical wasting may include >2-centile discrepancy between head circumference and weight.
Conditions, related rules & sources for BAPM: term-infant screening risks
- Other reasons to test include perinatal acidosis, infection, hypothermia <36.5°C not explained environmentally, cyanosis/apnea, altered consciousness, seizures, hypotonia, lethargy, high-pitched cry or abnormal feeding after good feeds. Jitteriness alone is not a screening indication under BAPM.
- Do not apply this framework to preterm infants or unwell infants already receiving intensive care; those groups need their appropriate local guidance.
- Practice Point 2 prints perinatal acidosis as cord/infant pH <7.1 and base deficit ≥−12 mmol/L. That sign convention is retained as printed, not corrected or interpreted by the app.
- Supporting p14 also advises glucose monitoring for pituitary/adrenal insufficiency, metabolic disease, congenital hyperinsulinism and Beckwith–Wiedemann; consider a planned screen for a first-degree relative with a heritable neonatal hypoglycemia disorder. Infection risk factors alone, without suspected/confirmed infection, are not that infection indication.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: second-centile birthweight reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Completed 37–42 weeks · kilograms · Reference data
BAPM Table 1 lists second-centile term birthweights by gestation and sex for its growth-restriction screening pathway. Do not substitute an arbitrary 2.5-kg cut-off or extend this term table to preterm babies.
- Source: BAPM’s NEWTT framework, as reproduced in the current hypoglycemia PDF. < versus ≤ screening wording differs between sections; values are not calculated.
- Practice Point 1/Flowchart A says <2nd centile; supporting p14 says ≤2nd. Clinical wasting can be important even above that centile; the exact equality wording remains unresolved.
- BAPM considers evidence insufficient for recommending customized growth charts to detect hypoglycemia risk. These are the source’s static reference values, not a patient classification tool.
Related rule sources & dates
- BAPM · Table 1; Practice Point 1; supporting p14
Identification and management of neonatal hypoglycaemia in the full-term infant, birth–72 hours · January 2024; document updates June 20 and September 16, 2024 (PDF p2)
Source checked 2026-10-27
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
Conditions, related rules & sources for BAPM: first check, monitoring and transfer
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
Conditions, related rules & sources for BAPM: operational thresholds
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
Conditions, related rules & sources for BAPM: feeding, warmth and parent partnership
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
Conditions, related rules & sources for BAPM: buccal glucose gel
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
Conditions, related rules & sources for BAPM: urgent investigation and critical samples
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
Conditions, related rules & sources for BAPM: suspected hyperinsulinism
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
Conditions, related rules & sources for BAPM: severe/symptomatic IV reference
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: published D10 infusion reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Appendix 4 · static glucose delivery rates
Appendix 4 lists glucose delivery at fixed D10 infusion rates. It is reference data, not a recommended rate for each infant. BAPM flags glucose need >8 mg/kg/min as a reason to suspect hyperinsulinism and contact specialists.
The document update log confirms a September 16, 2024 correction to the calculation formula on p29. This app displays only published static cells and performs no GIR or fluid-mixing calculation.
- Printed values/rounding are retained. This is a factual lookup table, not a calculator, prescription or fluid-mixing tool.
Conditions, related rules & sources for BAPM: published D10 infusion reference
- Clinical scope remains full-term birth–72 h; fluid/IV decisions require the source conditions and local policies.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: reliable glucose measurement
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Device validation, sampling and quality assurance
Use neonatal-validated devices with pathology/point-of-care team oversight. Blood-gas analyzers give rapid accurate low-range results; many handheld meters are unreliable at 0–2 mmol/L, but some newer meters are suitable when properly validated.
Train staff in sample requirements, device limits, quality checks and result recording. Use internal quality control plus external quality assessment with pathology-scientist oversight. Prefer the same measurement method for serial checks.
More conditions & sources (3) for BAPM: reliable glucose measurement
- Sample a warm, well-perfused heel or free-flowing venous/arterial blood with local comfort/asepsis procedures. Avoid capillary air bubbles; never sample a catheter carrying dextrose. Abnormal protein/lipid content can affect results.
- Record date/time, operator and device with results. This is source advice for clinical records; NICU Hearts does not collect clinical records.
- Do not repeat a glucose just because NEWTT2 says repeat observations: the June 2024 correction limits repeat BG to indications in the hypoglycemia pathway.
Source dates & verification
BAPM: reluctant feeding versus illness
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Healthy term infants; documented assessment within 6 h
Assess and document feeding within 6 h, distinguishing a well infant reluctant to feed from illness. Measure glucose if poor feeding follows earlier effective feeding or accompanies other abnormal signs; obtain prompt medical review for concerning findings.
Use safe skin-to-skin and laid-back feeding support; hand express and give milk until effective breastfeeding. After feeding is established, offer at least 8–10 feeds/24 h; hand express at least eight times daily if needed.
Conditions, related rules & sources for BAPM: reluctant feeding versus illness
- Flowchart D: assess wellbeing at least 4-hourly (parent concerns, colour, tone, breathing, temperature, alertness, nappies, sepsis risk); active feeding plans are reviewed every 2–4 h. Escalate any signs of illness.
- Appendix 2/Flowchart D recommend recording feeding assessments, listening to parental concerns, and avoiding teats, dummies and nipple shields while establishing breastfeeding. These are BAPM-specific supportive recommendations, not an automatic screening indication in every well reluctant feeder.
- Appendix 2: assisted feeds require a calm, alert, upright infant. Cup feeding lets the baby lap/sip; never pour milk into the mouth. Oral-syringe feeds go between gum and cheek, no more than 0.2 mL at a time with time to swallow; consider cup/paced bottle per policy/parent choice when >5 mL, or NG feeding if no feeding cues.
- After lactation is established, replace formula supplements with expressed milk if desired; Appendix 2 suggests no more than 20 mL formula per feed in addition to breastfeeding when top-ups are needed. Support informed parental choices and assess effective feeding/wet and dirty nappies.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: term-infant screening risks
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term ≥37 weeks · birth–72 h · Screening
Monitor term infants with fetal growth restriction/clinical wasting, maternal diabetes, or maternal beta-blocker exposure in the third trimester or at birth. BAPM does not recommend routine screening for LGA alone without maternal diabetes or Beckwith–Wiedemann features.
BAPM’s LGA and growth-percentile risk criteria differ from CPS/ABM; BAPM itself uses <2nd versus ≤2nd in different sections.
- Practice Point 1 and Flowchart A use birthweight <2nd centile or clinical wasting; supporting text p14 uses ≤2nd. That exact-boundary difference is unresolved. Clinical wasting may include >2-centile discrepancy between head circumference and weight.
- Other reasons to test include perinatal acidosis, infection, hypothermia <36.5°C not explained environmentally, cyanosis/apnea, altered consciousness, seizures, hypotonia, lethargy, high-pitched cry or abnormal feeding after good feeds. Jitteriness alone is not a screening indication under BAPM.
- Do not apply this framework to preterm infants or unwell infants already receiving intensive care; those groups need their appropriate local guidance.
- Practice Point 2 prints perinatal acidosis as cord/infant pH <7.1 and base deficit ≥−12 mmol/L. That sign convention is retained as printed, not corrected or interpreted by the app.
- Supporting p14 also advises glucose monitoring for pituitary/adrenal insufficiency, metabolic disease, congenital hyperinsulinism and Beckwith–Wiedemann; consider a planned screen for a first-degree relative with a heritable neonatal hypoglycemia disorder. Infection risk factors alone, without suspected/confirmed infection, are not that infection indication.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: second-centile birthweight reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Completed 37–42 weeks · kilograms · Reference data
BAPM Table 1 lists second-centile term birthweights by gestation and sex for its growth-restriction screening pathway. Do not substitute an arbitrary 2.5-kg cut-off or extend this term table to preterm babies.
- Source: BAPM’s NEWTT framework, as reproduced in the current hypoglycemia PDF. < versus ≤ screening wording differs between sections; values are not calculated.
- Practice Point 1/Flowchart A says <2nd centile; supporting p14 says ≤2nd. Clinical wasting can be important even above that centile; the exact equality wording remains unresolved.
- BAPM considers evidence insufficient for recommending customized growth charts to detect hypoglycemia risk. These are the source’s static reference values, not a patient classification tool.
Related rule sources & dates
- BAPM · Table 1; Practice Point 1; supporting p14
Identification and management of neonatal hypoglycaemia in the full-term infant, birth–72 hours · January 2024; document updates June 20 and September 16, 2024 (PDF p2)
Source checked 2026-10-27
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
BAPM: second-centile birthweight reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Completed 37–42 weeks · kilograms
BAPM Table 1 lists second-centile term birthweights by gestation and sex for its growth-restriction screening pathway. Do not substitute an arbitrary 2.5-kg cut-off or extend this term table to preterm babies.
Practice Point 1/Flowchart A says <2nd centile; supporting p14 says ≤2nd. Clinical wasting can be important even above that centile; the exact equality wording remains unresolved.
- Source: BAPM’s NEWTT framework, as reproduced in the current hypoglycemia PDF. < versus ≤ screening wording differs between sections; values are not calculated.
Conditions, related rules & sources for BAPM: second-centile birthweight reference
- BAPM considers evidence insufficient for recommending customized growth charts to detect hypoglycemia risk. These are the source’s static reference values, not a patient classification tool.
Source dates & verification
- BAPM · Table 1; Practice Point 1; supporting p14
Identification and management of neonatal hypoglycaemia in the full-term infant, birth–72 hours · January 2024; document updates June 20 and September 16, 2024 (PDF p2)
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
BAPM: term-infant screening risks
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term ≥37 weeks · birth–72 h · Screening
Monitor term infants with fetal growth restriction/clinical wasting, maternal diabetes, or maternal beta-blocker exposure in the third trimester or at birth. BAPM does not recommend routine screening for LGA alone without maternal diabetes or Beckwith–Wiedemann features.
BAPM’s LGA and growth-percentile risk criteria differ from CPS/ABM; BAPM itself uses <2nd versus ≤2nd in different sections.
- Practice Point 1 and Flowchart A use birthweight <2nd centile or clinical wasting; supporting text p14 uses ≤2nd. That exact-boundary difference is unresolved. Clinical wasting may include >2-centile discrepancy between head circumference and weight.
- Other reasons to test include perinatal acidosis, infection, hypothermia <36.5°C not explained environmentally, cyanosis/apnea, altered consciousness, seizures, hypotonia, lethargy, high-pitched cry or abnormal feeding after good feeds. Jitteriness alone is not a screening indication under BAPM.
- Do not apply this framework to preterm infants or unwell infants already receiving intensive care; those groups need their appropriate local guidance.
- Practice Point 2 prints perinatal acidosis as cord/infant pH <7.1 and base deficit ≥−12 mmol/L. That sign convention is retained as printed, not corrected or interpreted by the app.
- Supporting p14 also advises glucose monitoring for pituitary/adrenal insufficiency, metabolic disease, congenital hyperinsulinism and Beckwith–Wiedemann; consider a planned screen for a first-degree relative with a heritable neonatal hypoglycemia disorder. Infection risk factors alone, without suspected/confirmed infection, are not that infection indication.
Related rule sources & dates
BAPM: first check, monitoring and transfer
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Before second feed at 2–4 h; next before third feed by 8 h · Screening
For well at-risk term infants, feed within the first hour and measure glucose before the second feed (2–4 h). Flowchart A uses ≥2.0 mmol/L at the first and next pre-feed check, then no further testing unless clinical signs develop. Observe feeding in hospital for at least 24 h.
Within BAPM: intermediate ≥2.0 boxes versus >2.0 stopping/transfer wording. No equality rule is inferred.
- Practice Point 17 additionally says remain until two consecutive values >2.0 mmol/L and effective feeding maintained over several fast–feed cycles. Flowchart B likewise stops after two >2.0 values, although its intermediate decision boxes use ≥2.0. The equality wording differs within this source.
- BAPM does not recommend a routine 1–2-h glucose measurement. A low result obtained incidentally still requires urgent clinical assessment. Symptoms prompt immediate testing/assessment rather than waiting for a scheduled screen.
- Provide at least one recorded breastfeeding assessment before transfer. Prolonged or very frequent feeds can make a true pre-feed sample difficult and may require longer monitoring.
- The June 20, 2024 correction to Practice Point 8 says NEWTT2 glucose 2.0–2.5 triggers repeat observations at 1 h excluding glucose; repeat glucose only when indicated by the hypoglycemia guidance.
Related rule sources & dates
BAPM: operational thresholds
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Full-term first 72 h · symptoms and repeated values matter · Thresholds
BAPM’s executive thresholds are <1.0 mmol/L at any time; one <2.5 with abnormal clinical signs; or more than two <2.0 in an at-risk infant without signs. Initial 1.0–1.9 already receives feeding support ±gel; do not wait for three low results to provide treatment.
BAPM values are not CPS’s 2.6/3.3 thresholds. BAPM also has a 48-h versus 72-h persistence wording difference.
- Practice Point 18 permits gel with feeding at the first 1.0–1.9 result or a later <2.0. Flowchart B’s bounded repeat and repeated-low escalation options are given locally below.
- Flowchart B (pre-feed 1.0–1.9 mmol/L, no abnormal signs), first unsuccessful ≥2.0 mmol/L check: after feeding support ±40% gel, recheck before the third feed and no later than 8 h after birth. If that ≥2.0 check is not met, repeat ONE loop, then see Box 3; the diagram does not provide unlimited feeding/gel repeat loops.
- Flowchart B, later unsuccessful ≥2.0 mmol/L check: after the first successful check, give a feed and check before the next feed. If this later check is not ≥2.0, go directly to Box 3; its arrow does not give another repeat loop.
- Flowchart B Box 3: with more than two measurements of 1.0–1.9 mmol/L, inform the neonatal team, investigate the cause and consider sepsis. Consider increased feed frequency, nasogastric tube insertion or an IV infusion of 10% glucose. These are conditional options in this repeated-low, no-abnormal-signs branch, not mandatory simultaneous treatments.
- Severe <1.0 requires urgent review and IV treatment; gel is only an interim bridge during IV delay. Neurological signs with BG <2.5 require urgent neonatal/pediatric referral.
- Executive Summary p6 calls persistent >2 values <2.0 in the first 48 h; Practice Points 21/23 use the first 72 h. This within-source duration difference is explicit, not silently resolved.
- The supporting summary on p18 instead describes <2.0 remaining <2.0 at the next measurement (two readings), versus the executive’s more-than-two wording. These source formulations are distinct. Flowchart B still provides initial feeding/gel care; no waiting rule is inferred.
Related rule sources & dates
BAPM: feeding, warmth and parent partnership
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Feed within 60 min; no >3-h gap until two BG >2.0 · Management
Dry, hat and warm the newborn; use safe skin-to-skin care and support effective breastfeeds within the first hour. Assess feeding, offer responsive feeds and prevent gaps over 3 h until two glucose readings >2.0 mmol/L.
- Support hand expression at least 8–10 times/24 h and give available colostrum if attachment/feeding is ineffective. Observe positioning, suck and milk transfer; avoid unnecessary separation.
- If formula is used, BAPM gives 40–60 mL/kg/day for 0–24 h, 70–90 for 24–48 h, 100–120 for 48–72 h, generally in 3-hourly feeds. These are static term-framework references, not a calculated prescription.
- BAPM finds insufficient evidence to recommend donor milk for term hypoglycemia; this differs from ABM’s donor-milk supplementation option.
- Give parents verbal/written reasons for tests, prevention/feeding advice, signs of illness and a clear way to raise concerns. Observe and document clinical status and use local feeding assessments.
- Appendix 1 explains first testing, concerning feeding/colour/tone/breathing/temperature (36.5–37.5°C) and when to alert staff or seek urgent help using locally supplied numbers. At discharge after stability, teach effective feeding and at least 8 feeds/24 h; responsive feeding replaces waking every 2–3 h unless a specific reason requires it. Do not overfeed by insisting a bottle is finished. Antenatal expression should be discussed with the maternity team.
Related rule sources & dates
BAPM: buccal glucose gel
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
40% gel 200 mg/kg ≈0.5 mL/kg · with a feeding plan · Management
BAPM permits gel with feeding for BG 1.0–1.9 mmol/L without abnormal signs. For severe BG <1.0, use only as an interim measure while arranging urgent IV treatment. Appendix 3 allows up to two doses 30 min apart per episode, maximum six doses in 48 h.
- BAPM’s rounded weight-band table accompanies its nominal 200 mg/kg description. Values are reproduced, not recomputed, and do not extend the term-only framework to excluded populations.
- Feed immediately after gel; severe/symptomatic low glucose needs urgent medical/IV care.
- Discuss any dose beyond the first with the neonatal team; BAPM advises examining the infant before a third dose. Maxima do not replace assessment or escalation for persistent/severe hypoglycemia.
- Use buccally: dry the mucosa, apply to the inner cheek with an oral/enteral syringe without a needle, massage using latex-free gloves, then offer milk immediately, preferably breast milk.
- The source notes approximate product glucose content 400 mg/mL and pharmacy advice if needed. The banded table contains published rounded quantities; it is a static table, without calculations.
- Flowchart B rechecks before the third feed, by 8 h, then before the next feed. The first unsuccessful ≥2.0 check repeats ONE loop then Box 3; the later unsuccessful check goes straight to Box 3. Its complete repeated-low escalation options are in the local related BAPM threshold rule. Signs move to Flowchart C; Appendix 3’s 30-min repeat-dose wording is separately retained.
- BAPM does not recommend prophylactic 40% gel. Its evidence review cautions that gel trial findings do not apply to symptomatic, severe, prolonged or recurrent hypoglycemia; gel in those settings is only an emergency bridge if IV is delayed and IM glucagon unavailable.
Related rule sources & dates
BAPM: urgent investigation and critical samples
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
Severe <1.0; >2 readings <2.0; neurological signs with <2.5 · Investigation
Practice Point 21 directs urgent neonatal/pediatric referral for severe BG <1.0 at any time, >2 BG values <2.0 within 72 h, or acute neurological dysfunction with BG <2.5. Obtain samples before treatment if possible, without delaying treatment.
Unresolved persistence period: executive 48 h versus detailed practice 72 h.
- Prioritize glucose, insulin plus C-peptide, free fatty acids, and beta-hydroxybutyrate (or point-of-care ketones). Also consider infection testing, cortisol, growth hormone, acylcarnitines, amino acids, ammonia, lactate; urine ketones and organic acids. Record glucose context and involve specialists for further tests.
- One or two 1.0–1.9 readings in the first 72 h in a well infant feeding effectively do not require this full panel. This does not mean no feeding treatment or follow-up is needed.
- BAPM executive text says first 48 h for persistence, while Practice Points 21/23 say 72 h; both are disclosed locally. Severe/neurological presentations require neonatal-unit neurocritical care, investigation and monitoring.
- The supporting evidence pp19–20 recommends brain MRI and long-term follow-up after hypoglycemia with abnormal neurological signs, alongside neonatal neurocritical monitoring.
Related rule sources & dates
BAPM: severe/symptomatic IV reference
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
BG <1.0 mmol/L and/or signs · Flowchart C · Management
For severe/symptomatic hypoglycemia, obtain urgent medical review, IV access and neonatal admission. Flowchart C specifies D10 2.5 mL/kg followed by 60 mL/kg/day, with glucose rechecked after 30 min. Take confirmation/critical samples without delaying treatment; consider sepsis.
Body-specific IV starting volumes differ from CPS/ABM. BAPM’s hyperinsulinism timing conflict is preserved.
- If immediate IV access is unavailable, BAPM describes 40% buccal gel 200 mg/kg or IM glucagon 200 micrograms/kg (Practice Point 19 maximum 1 mg once) as bridges. Severe <1.0 is not managed with gel alone.
- Flowchart C: persistent <1.0 or abnormal signs → repeat D10 2.5 mL/kg, increase glucose delivery by 2 mg/kg/min and recheck in 30 min. At 1.0–2.5 with no signs, increase delivery by 2 mg/kg/min and recheck in 30 min. These published steps are static, not calculated for an entered patient.
- If >2.5 and clinically stable, slowly wean IV and continue feeds if not contraindicated. Monitor until full feeds and values >2.5 (or hyperinsulinism goal 3.0), across several fast–feed cycles for at least 24 h.
- Flowchart C weaning box says >3.5 after 72 h for all babies; its footnote/Practice Point 25 uses >3.5 after 48 h for hyperinsulinism. The framework otherwise ends at 72 h; do not infer a universal post-72-h regimen.
Related rule sources & dates
BAPM: suspected hyperinsulinism
Full-term ≥37 weeks, birth–72 h. Excludes preterm babies and unwell babies receiving intensive care.
>2 low readings despite feeds, or glucose need >8 mg/kg/min · Investigation
Consider hyperinsulinism if BG stays <2.0 mmol/L on >2 occasions in the first 72 h despite adequate energy/feeding, or glucose requirement exceeds 8 mg/kg/min. Involve specialists promptly; Practice Point 25 targets >3.0 mmol/L for the first 48 h and >3.5 thereafter.
BAPM target timing differs within its flowchart: hyperinsulinism footnote/Practice Point 25 use 48 h, weaning box uses 72 h.
- Measure insulin/C-peptide and the hypoglycemia screen; BAPM also discusses the insulin:C-peptide molar ratio when excluding exogenous insulin exposure.
- Flowchart C footnote similarly raises targets at >48 h, but its weaning box says >3.5 after 72 h for all babies. These are not silently made into one rule.
- Beyond 72 h this framework ends; follow appropriate local pediatric guidance with specialist input.
- Supporting p18 advises investigation if BG <3.0 mmol/L in suspected hyperinsulinism, and states 3.5 after 72 h, versus 48 h in Practice Point 25/p20. Its HIE discussion mentions an operational threshold at least 2.5 mmol/L in moderate–severe HIE and avoiding hyperglycemia; this is contextual advice, not extension of the term well-infant pathway to unwell intensive-care babies.
Related rule sources & dates
Phototherapy: choose the right AAP threshold
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age in hours · GA ≥35 weeks
Use intensive phototherapy at the published GA-, age- and neurotoxicity-risk-specific TSB threshold. Use total bilirubin; do not subtract the direct or conjugated fraction.
GA is already built into the curves: at 35–37 6/7 weeks with no additional neurotoxicity risk, use Figure 2 / Supplemental Table 1. With an additional risk factor use Figure 3 / Table 2; ≥38 weeks are grouped in the latter.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for Phototherapy: choose the right AAP threshold
- Thresholds are based on expert opinion, rather than a proven boundary of benefit versus harm. Selected subthreshold treatment is an option after considering readmission likelihood, overtreatment and family preferences; it is not a universal lower threshold.
- If direct/conjugated bilirubin exceeds 50% of TSB in severe hyperbilirubinemia, consult an expert. A TSB at/above the treatment threshold before 24 h suggests hemolysis and requires evaluation.
- Intensive phototherapy: narrow-spectrum LED blue light, ≥30 μW/cm²/nm around 475 nm, over as much skin as possible. Source wavelengths outside 460–490 nm add unnecessary heat/potential harm.
- The 18 published numeric grids are available locally under “AAP threshold tables”; they are static reference data, not a calculator.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: investigate jaundice requiring phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At phototherapy initiation; nonresponse or escalation · Investigation
Obtain hemoglobin, hematocrit or CBC to assess anemia and establish a baseline. Obtain DAT when mother has a positive antibody screen, is group O regardless of Rh status, or is Rh(D) negative.
AAP threshold tables · published mg/dL values →
- Measure G6PD activity for unexplained jaundice with TSB rising despite intensive phototherapy, a sudden rise, rise after an initial fall, or escalation of care. A first-day TSB above treatment threshold suggests hemolysis.
- G6PD testing during/soon after hemolysis or exchange can be falsely normal; if suspicion persists despite a normal/near-normal result, repeat ≥3 months later. An absent family history does not exclude G6PD deficiency.
- Consult neonatology/hematology for difficult rising bilirubin despite intensive treatment. Consider RBC membrane disorders; genomic sequencing may help with otherwise unexplained hemolysis requiring escalation.
Related rule sources & dates
- AAP · KAS 14; G6PD discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 8
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP neurotoxicity risk factors
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
Conditions, related rules & sources for AAP: who needs closer jaundice surveillance?
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Source dates & verification
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
Conditions, related rules & sources for AAP: maternal antibodies and DAT testing
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Source dates & verification
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
Conditions, related rules & sources for AAP: when to screen bilirubin
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: when TcB needs serum confirmation
Source dates & verification
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: rapid bilirubin rise and hemolysis
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
First 24 h: ≥0.3 mg/dL/h · thereafter: ≥0.2 mg/dL/h
When serial TcB/TSB values are available, an exceptional rise of ≥0.3 mg/dL/h in the first 24 h or ≥0.2 mg/dL/h thereafter suggests hemolysis. Obtain DAT if not already done.
KAS 7 and 2024 Table 2 use ≥; 2022 Table 1 uses > at the same values. NICE advises against ETCOc to predict significant hyperbilirubinemia; purposes differ.
End-tidal carbon monoxide corrected for ambient CO, when available, may help quantify hemolysis. This is a published general rate reference; the app does not calculate a patient trajectory.
Conditions, related rules & sources for AAP: rapid bilirubin rise and hemolysis
Source dates & verification
- AAP · KAS 7 and discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 3
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: investigate jaundice requiring phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At phototherapy initiation; nonresponse or escalation · Investigation
Obtain hemoglobin, hematocrit or CBC to assess anemia and establish a baseline. Obtain DAT when mother has a positive antibody screen, is group O regardless of Rh status, or is Rh(D) negative.
AAP threshold tables · published mg/dL values →
- Measure G6PD activity for unexplained jaundice with TSB rising despite intensive phototherapy, a sudden rise, rise after an initial fall, or escalation of care. A first-day TSB above treatment threshold suggests hemolysis.
- G6PD testing during/soon after hemolysis or exchange can be falsely normal; if suspicion persists despite a normal/near-normal result, repeat ≥3 months later. An absent family history does not exclude G6PD deficiency.
- Consult neonatology/hematology for difficult rising bilirubin despite intensive treatment. Consider RBC membrane disorders; genomic sequencing may help with otherwise unexplained hemolysis requiring escalation.
Related rule sources & dates
- AAP · KAS 14; G6PD discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 8
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: feeding support and jaundice
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: home phototherapy eligibility
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: monitor during phototherapy
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Source dates & verification
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: investigate jaundice requiring phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At phototherapy initiation; nonresponse or escalation
Obtain hemoglobin, hematocrit or CBC to assess anemia and establish a baseline. Obtain DAT when mother has a positive antibody screen, is group O regardless of Rh status, or is Rh(D) negative.
Measure G6PD activity for unexplained jaundice with TSB rising despite intensive phototherapy, a sudden rise, rise after an initial fall, or escalation of care. A first-day TSB above treatment threshold suggests hemolysis.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: investigate jaundice requiring phototherapy
- G6PD testing during/soon after hemolysis or exchange can be falsely normal; if suspicion persists despite a normal/near-normal result, repeat ≥3 months later. An absent family history does not exclude G6PD deficiency.
- Consult neonatology/hematology for difficult rising bilirubin despite intensive treatment. Consider RBC membrane disorders; genomic sequencing may help with otherwise unexplained hemolysis requiring escalation.
Source dates & verification
- AAP · KAS 14; G6PD discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 8
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP 2022: stopping phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the hour-specific threshold at treatment START
Stopping phototherapy is an option when TSB is at least 2 mg/dL below the hour-specific threshold that applied when phototherapy began. Longer treatment is an option with rebound risks, including GA <38 weeks, treatment started <48 h or hemolysis.
AAP 2024 technical Table 2 row 9 says 2–4 mg/dL below the starting threshold. The 2022 KAS 15 says at least 2 mg/dL; the app does not infer that the later technical report replaces it.
Compare with the threshold at initiation, not simply a falling current bilirubin or a current-age threshold. Arrange coordinated rebound follow-up. Early treatment, particularly <24 h, raises concern for hemolysis.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP 2022: stopping phototherapy
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP 2022: rebound checks after phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk- and treatment-setting-specific follow-up · Monitoring
For infants exceeding threshold during birth hospitalization with phototherapy begun <48 h, positive DAT or known/suspected hemolysis: check TSB 6–12 h after stopping AND again the next day. Other infants treated above threshold during birth hospitalization need a next-day bilirubin check.
AAP 2024 Table 2 row 10 instead says 8–12 h plus next day for <48 h start, GA <38 weeks, DAT+ or suspected hemolysis, and 1–2 days for all others. Both document-specific rules are shown.
AAP threshold tables · published mg/dL values →
- If previously treated during birth hospitalization and then readmitted above threshold, check bilirubin the day after stopping.
- For first phototherapy after readmission or home phototherapy exceeding threshold, check bilirubin in 1–2 days OR arrange clinical follow-up in 1–2 days to decide testing. Consider GA <38 weeks, stopping TSB versus threshold, feeding/weight gain and other risks.
- TcB may replace TSB only when ≥24 h have passed since stopping. Except for the specific high-risk early check, allow at least 12 h, preferably 24 h, to assess rebound. Rebound means reaching treatment threshold within 72–96 h of stopping.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP 2022: rebound checks after phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk- and treatment-setting-specific follow-up
For infants exceeding threshold during birth hospitalization with phototherapy begun <48 h, positive DAT or known/suspected hemolysis: check TSB 6–12 h after stopping AND again the next day. Other infants treated above threshold during birth hospitalization need a next-day bilirubin check.
AAP 2024 Table 2 row 10 instead says 8–12 h plus next day for <48 h start, GA <38 weeks, DAT+ or suspected hemolysis, and 1–2 days for all others. Both document-specific rules are shown.
If previously treated during birth hospitalization and then readmitted above threshold, check bilirubin the day after stopping.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP 2022: rebound checks after phototherapy
- For first phototherapy after readmission or home phototherapy exceeding threshold, check bilirubin in 1–2 days OR arrange clinical follow-up in 1–2 days to decide testing. Consider GA <38 weeks, stopping TSB versus threshold, feeding/weight gain and other risks.
- TcB may replace TSB only when ≥24 h have passed since stopping. Except for the specific high-risk early check, allow at least 12 h, preferably 24 h, to assess rebound. Rebound means reaching treatment threshold within 72–96 h of stopping.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: prolonged jaundice and direct bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Breastfed: 3–4 weeks · formula-fed: 2 weeks
Measure total and direct-reacting/conjugated bilirubin when jaundice persists to 3–4 weeks in breastfed infants or 2 weeks in formula-fed infants. Review newborn screening results, including metabolic/thyroid disorders.
Seek gastroenterology/other expert input for any prolonged jaundice in a formula-fed infant, or direct/conjugated hyperbilirubinemia in a breastfed infant.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: prolonged jaundice and direct bilirubin
- AAP cites direct bilirubin >1.0 mg/dL as abnormal and notes ≥0.3 mg/dL has been used for conjugated bilirubin; the assays differ and laboratory ranges vary. One elevation alone usually does not mean biliary atresia. Repeat within a few days to 2 weeks improves assessment; a rising level needs evaluation.
- Direct >20% of total is not required to diagnose cholestasis. Consider UTI, isoimmune hemolysis, sepsis and inborn errors as well as biliary atresia. For ≥7-day persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate bilirubin and assess causes.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: escalation is a medical emergency
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
Conditions, related rules & sources for AAP: IVIG is a conditional option
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Source dates & verification
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: urgent exchange transfusion
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Source dates & verification
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP: predischarge follow-up planning
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: reliable jaundice systems and family education
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth setting, transfer and community follow-up
Establish written jaundice assessment/testing protocols, equipment checks and rapid-transfer plans that maintain phototherapy. Arrange accessible bilirubin testing and results/follow-up support, including weekends and holidays.
Use a family-centered setting that supports breastfeeding/bonding. Educate about jaundice and potential hemolysis triggers; remove the former assumption that Black race is protective.
Conditions, related rules & sources for AAP: reliable jaundice systems and family education
- The FAQ lists fava beans, mothballs, henna and herbal remedies as potential oxidative triggers; advise review of medicines/antibiotics rather than a blanket prohibition. Do not infer an infant’s G6PD status from race.
- AAP does not currently recommend universal G6PD screening; close follow-up and universal caregiver education remain important. The FAQ’s New York mandate is legal background, not an independently verified current legal instruction in this app.
- Do not use sunlight as a routine treatment, or phototherapy solely to prevent subtle adverse neurodevelopmental findings below established treatment levels. The 2022 guideline is designed for settings with screening, follow-up and treatment resources.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP technical report: effective light delivery
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Device setup and ongoing efficacy checks
Prefer narrow-band blue-green LED light at 460–490 nm, with optimal peak around 478 nm. Measure irradiance using the device manufacturer’s recommended meter, distance and orientation; visual brightness and ordinary light/color meters are unsuitable.
The 2024 introduction describes 25–35 μW/cm²/nm; its irradiance section describes 30 (range 25–35), while the abstract specifies ≥30 for term infants. The 2022 guideline specifies ≥30 around 475 nm. These are document-specific descriptions.
- These are values in the 2024 report, not reverified manufacturer specifications. Table 1 combines overhead/blanket neoBLUE entries; the footprint unit is not printed there. Use the specific manufacturer’s instructions; no equivalence is inferred.
More conditions & sources (4) for AAP technical report: effective light delivery
- Increasing irradiance beyond >35 μW/cm²/nm may plateau in effect; safety/benefit of much higher doses is unestablished. Avoid halogen/tungsten sources because of burn risk. Moving a spotlight closer may reduce exposed skin area.
- Lamp output decreases with use. Record duration, devices, daily skin-level irradiance and exposed body surface. The center/periphery can differ; meters are not standardized across devices.
- Approximately 35% of body surface is exposed with a single planar ventral/dorsal method. Maximize effective exposed surface without shadows or equipment obstruction; multiple devices may increase coverage. For incubators, light perpendicular to the surface reduces reflection.
- Number of lamps (“double/triple”) alone does not describe efficacy. The report’s Table 1 is a 2024 device comparison, not a current product recommendation; manufacturer-specific specifications are available in local details.
Source dates & verification
AAP technical report: response and interruptions
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Response normally apparent within 4 h
The report anticipates a TSB fall >2 mg/dL (34 μmol/L) within 4 h of effective phototherapy. Monitor actual serial TSB and use the 2022 guideline’s monitoring/escalation approach; ongoing hemolysis and ineffective delivery can alter response.
Do not turn an anticipated response into a substitute treatment threshold. Verify device, intensity and skin coverage if response is inadequate.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP technical report: response and interruptions
- Distinguish continuous uninterrupted exposure during escalation from continual treatment with brief handling, bonding and feeding interruptions. Cycled treatment in extremely low birthweight infants remains investigational; do not extrapolate this ≥35-week reference to very preterm care.
Source dates & verification
- AAP · II.D/E; Table 2 monitoring rows
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: investigate jaundice requiring phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At phototherapy initiation; nonresponse or escalation · Investigation
Obtain hemoglobin, hematocrit or CBC to assess anemia and establish a baseline. Obtain DAT when mother has a positive antibody screen, is group O regardless of Rh status, or is Rh(D) negative.
AAP threshold tables · published mg/dL values →
- Measure G6PD activity for unexplained jaundice with TSB rising despite intensive phototherapy, a sudden rise, rise after an initial fall, or escalation of care. A first-day TSB above treatment threshold suggests hemolysis.
- G6PD testing during/soon after hemolysis or exchange can be falsely normal; if suspicion persists despite a normal/near-normal result, repeat ≥3 months later. An absent family history does not exclude G6PD deficiency.
- Consult neonatology/hematology for difficult rising bilirubin despite intensive treatment. Consider RBC membrane disorders; genomic sequencing may help with otherwise unexplained hemolysis requiring escalation.
Related rule sources & dates
- AAP · KAS 14; G6PD discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 8
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP technical report: effective light delivery
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Device setup and ongoing efficacy checks · Reference data
Prefer narrow-band blue-green LED light at 460–490 nm, with optimal peak around 478 nm. Measure irradiance using the device manufacturer’s recommended meter, distance and orientation; visual brightness and ordinary light/color meters are unsuitable.
- These are values in the 2024 report, not reverified manufacturer specifications. Table 1 combines overhead/blanket neoBLUE entries; the footprint unit is not printed there. Use the specific manufacturer’s instructions; no equivalence is inferred.
- The 2024 introduction describes 25–35 μW/cm²/nm; its irradiance section describes 30 (range 25–35), while the abstract specifies ≥30 for term infants. The 2022 guideline specifies ≥30 around 475 nm. These are document-specific descriptions.
- Increasing irradiance beyond >35 μW/cm²/nm may plateau in effect; safety/benefit of much higher doses is unestablished. Avoid halogen/tungsten sources because of burn risk. Moving a spotlight closer may reduce exposed skin area.
- Lamp output decreases with use. Record duration, devices, daily skin-level irradiance and exposed body surface. The center/periphery can differ; meters are not standardized across devices.
- Approximately 35% of body surface is exposed with a single planar ventral/dorsal method. Maximize effective exposed surface without shadows or equipment obstruction; multiple devices may increase coverage. For incubators, light perpendicular to the surface reduces reflection.
- Number of lamps (“double/triple”) alone does not describe efficacy. The report’s Table 1 is a 2024 device comparison, not a current product recommendation; manufacturer-specific specifications are available in local details.
Related rule sources & dates
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP 2024: stopping and rebound wording
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Technical report Table 2 rows 9–10
The 2024 technical report describes stopping as an option when TSB is 2–4 mg/dL below the starting hour-specific threshold. It specifies a TSB at 8–12 h after stopping AND the next day for treatment started <48 h, GA <38 weeks, DAT+ or suspected hemolysis.
Within AAP: 2022 KAS 15 says ≥2 mg/dL below starting threshold; KAS 16 high-risk early testing is 6–12 h and is setting-specific. The 2024 table says 2–4 mg/dL and 8–12 h, includes GA <38 weeks, and uses a broader other-infant 1–2-day rule.
Its table gives a follow-up TSB within 1–2 days for other treated infants; further testing depends on level/trajectory. Use TSB unless ≥24 h have elapsed after stopping, when TcB is an option.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP 2024: stopping and rebound wording
- Consider cause, starting level, gap from treatment threshold and rebound risk when stopping. Do not silently replace the 2022 guideline’s exact setting-specific follow-up rules with this table.
Source dates & verification
- AAP · Table 2 rows 9/10
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP 2022: stopping phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the hour-specific threshold at treatment START · Conditional option
Stopping phototherapy is an option when TSB is at least 2 mg/dL below the hour-specific threshold that applied when phototherapy began. Longer treatment is an option with rebound risks, including GA <38 weeks, treatment started <48 h or hemolysis.
AAP 2024 technical Table 2 row 9 says 2–4 mg/dL below the starting threshold. The 2022 KAS 15 says at least 2 mg/dL; the app does not infer that the later technical report replaces it.
AAP threshold tables · published mg/dL values →
- Compare with the threshold at initiation, not simply a falling current bilirubin or a current-age threshold. Arrange coordinated rebound follow-up. Early treatment, particularly <24 h, raises concern for hemolysis.
Related rule sources & dates
AAP 2022: rebound checks after phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk- and treatment-setting-specific follow-up · Monitoring
For infants exceeding threshold during birth hospitalization with phototherapy begun <48 h, positive DAT or known/suspected hemolysis: check TSB 6–12 h after stopping AND again the next day. Other infants treated above threshold during birth hospitalization need a next-day bilirubin check.
AAP 2024 Table 2 row 10 instead says 8–12 h plus next day for <48 h start, GA <38 weeks, DAT+ or suspected hemolysis, and 1–2 days for all others. Both document-specific rules are shown.
AAP threshold tables · published mg/dL values →
- If previously treated during birth hospitalization and then readmitted above threshold, check bilirubin the day after stopping.
- For first phototherapy after readmission or home phototherapy exceeding threshold, check bilirubin in 1–2 days OR arrange clinical follow-up in 1–2 days to decide testing. Consider GA <38 weeks, stopping TSB versus threshold, feeding/weight gain and other risks.
- TcB may replace TSB only when ≥24 h have passed since stopping. Except for the specific high-risk early check, allow at least 12 h, preferably 24 h, to assess rebound. Rebound means reaching treatment threshold within 72–96 h of stopping.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP 2024: escalation wording
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Within 0–2 mg/dL below exchange threshold, or at/above it
The technical report describes escalation at or above exchange threshold or within 0–2 mg/dL below it. Give emergent intensive phototherapy and IV hydration as soon as possible, with TSB at least every 2 h until escalation ends.
Within AAP: the technical report’s row 12 conditional transfer wording differs from KAS 19’s consultation during escalation. The app does not resolve precedence or advise delaying consultation.
Table 2 row 12 says to consult neonatology about NICU transfer if bilirubin continues rising despite this intervention. The 2022 KAS 19 instead calls for neonatology consultation about urgent exchange-capable NICU transfer for infants requiring escalation; it does not require waiting for another rise.
AAP threshold tables · published mg/dL values →
Conditions, related rules & sources for AAP 2024: escalation wording
- The report’s selected table is not a complete replacement for the guideline’s STAT investigations, threshold selection, exchange/encephalopathy indications and coordinated emergency protocol, provided in the related local rules.
Source dates & verification
- AAP · Table 2 rows 11–13
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP technical report: effective light delivery
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
Device setup and ongoing efficacy checks · Reference data
Prefer narrow-band blue-green LED light at 460–490 nm, with optimal peak around 478 nm. Measure irradiance using the device manufacturer’s recommended meter, distance and orientation; visual brightness and ordinary light/color meters are unsuitable.
- These are values in the 2024 report, not reverified manufacturer specifications. Table 1 combines overhead/blanket neoBLUE entries; the footprint unit is not printed there. Use the specific manufacturer’s instructions; no equivalence is inferred.
- The 2024 introduction describes 25–35 μW/cm²/nm; its irradiance section describes 30 (range 25–35), while the abstract specifies ≥30 for term infants. The 2022 guideline specifies ≥30 around 475 nm. These are document-specific descriptions.
- Increasing irradiance beyond >35 μW/cm²/nm may plateau in effect; safety/benefit of much higher doses is unestablished. Avoid halogen/tungsten sources because of burn risk. Moving a spotlight closer may reduce exposed skin area.
- Lamp output decreases with use. Record duration, devices, daily skin-level irradiance and exposed body surface. The center/periphery can differ; meters are not standardized across devices.
- Approximately 35% of body surface is exposed with a single planar ventral/dorsal method. Maximize effective exposed surface without shadows or equipment obstruction; multiple devices may increase coverage. For incubators, light perpendicular to the surface reduces reflection.
- Number of lamps (“double/triple”) alone does not describe efficacy. The report’s Table 1 is a 2024 device comparison, not a current product recommendation; manufacturer-specific specifications are available in local details.
Related rule sources & dates
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
AAP technical report: safety and contraindications
AAP technical report · Birth ≥35 weeks; supports 2022 guideline, with document differences retained.
During supervised phototherapy
Assess hydration, temperature, nutrition and clinical status; monitor serial TSB and signs of evolving acute bilirubin encephalopathy. Use safe supine positioning and keep eye masks in place; remove them for brief supervised feeding/bonding breaks.
Signs described include altered feeding, lethargy, inconsolability, high-pitched cry, hypotonia/hypertonia, opisthotonos, retrocollis or fever. Routine prone/supine alternation does not improve treatment and can compromise safe sleep.
Conditions, related rules & sources for AAP technical report: safety and contraindications
- The safety section lists congenital porphyria and photosensitizing drugs as contraindications; the risk section also lists albinism. Use caution with cholestasis or exfoliative skin disease. Phototherapy does not reduce conjugated bilirubin and may cause reversible skin bronzing.
- IV tubing/infusions delivering multivitamins and intralipids may need light protection. Devices used with oxygen/high humidity must meet electrical/fire standards; maintain routine hygiene, with diapers for hygiene rather than proven gonadal protection.
- Use supervised monitoring, an escalation process and appropriate setting/GA adjustment. Do not recommend undressed home sunlight exposure: UV/IR, temperature changes and burns cannot be controlled as a prescribed dose.
- Long-term risk associations are not established causation. Table 4 evidence is heterogeneous/confounded; suspected seizure/cancer associations require further validation before changing guideline practice. Avoid overtreatment and support lactation/parent-infant contact. The report does not address <32-week treatment.
Source dates & verification
- AAP · IV–VII; Tables 3/4; risk discussion
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP neurotoxicity risk factors
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Risk assessment before choosing treatment curves · Risk factors
Neurotoxicity risks are GA <38 weeks, albumin <3.0 g/dL, isoimmune hemolytic disease, G6PD deficiency or another hemolytic condition, sepsis, and significant clinical instability in the preceding 24 h.
AAP threshold tables · published mg/dL values →
- GA is incorporated separately in the GA-specific curves; use the additional-risk curves for risks beyond GA. Clinical judgment is needed for sepsis/instability; AAP gives no specific pH cutoff.
- Albumin and DAT are not automatic universal tests. Measure albumin when low albumin is suspected or escalation-of-care threshold is reached; DAT testing follows clinical and maternal-antibody indications.
Related rule sources & dates
AAP: monitor during phototherapy
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
In hospital: TSB within 12 h after starting · Monitoring
Measure TSB within 12 h of starting inpatient phototherapy. Set the initial timing and subsequent frequency using age, neurotoxicity risks, TSB value and its trajectory.
AAP 2022 says within 12 h; CPS says within 12–24 h; NICE says 4–6 h initially then every 6–12 h when stable/falling.
AAP threshold tables · published mg/dL values →
- Home phototherapy needs daily TSB and the inpatient-admission criteria in the related home rule. Escalation requires TSB at least every 2 h.
- For efficacy, verify intended irradiance using manufacturer instructions; intensity varies across the light footprint. Provide treatment in the mother’s room when possible.
Related rule sources & dates
- AAP · KAS 12; Providing phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 row 6
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: escalation is a medical emergency
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TSB ≥2 mg/dL below the exchange threshold · Escalation
Escalate when TSB reaches or exceeds the escalation threshold, defined as 2 mg/dL below exchange threshold. Begin emergent intensive phototherapy and IV hydration, consult neonatology and arrange urgent transfer to an exchange-capable NICU when needed.
AAP threshold tables · published mg/dL values →
- Use GA/hour-specific exchange thresholds; Figure 6 / Table 4 applies with additional neurotoxicity risks OR TSB rising despite phototherapy. Do not subtract direct bilirubin. The first-24-hour exchange curves carry explicit uncertainty.
- Send STAT total/direct bilirubin, CBC, albumin, chemistries, and type/crossmatch. Check TSB at least every 2 h until it is below escalation threshold; then return to phototherapy monitoring.
- Continue intensive phototherapy and IV hydration during transfer if possible; direct NICU admission can avoid delay. This record covers KAS 17–20 and written guidance; the full Figure 4 graphic could not be visually verified.
Related rule sources & dates
AAP: maternal antibodies and DAT testing
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
As soon as possible after birth when indicated · Screening
If the maternal antibody screen is positive or unknown because prenatal screening was not performed, obtain infant DAT and blood type promptly using cord or peripheral blood. DAT-negative infants can receive usual care.
- A DAT positive only to anti-D after maternal RhIG may be treated as negative if the mother was known not to have anti-D before RhIG. Other antibody-related DAT positivity after RhIG still counts as positive.
- If maternal Rh(D) is negative, determine infant Rh type for maternal RhIG eligibility. If mother is O+ with negative antibody screen, cord infant type/DAT is optional when guideline bilirubin surveillance, risk assessment and reliable follow-up are in place; otherwise test.
- The full Figure 1 early-management diagram could not be visually verified in this batch; this record covers KAS 1 and its written conditions, not every diagram branch.
Related rule sources & dates
- AAP · KAS 1 and accompanying text
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when TcB needs serum confirmation
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
TcB within 3 mg/dL of treatment threshold, above it, or ≥15 mg/dL · Screening
Obtain TSB if TcB exceeds the phototherapy threshold, is within 3 mg/dL of that threshold, or is ≥15 mg/dL. TSB is the definitive test for phototherapy, escalation and exchange decisions.
AAP threshold tables · published mg/dL values →
- During phototherapy, exposed-skin TcB underestimates TSB. Covered-skin measurements have mixed accuracy; establish correlation with TSB in the individual infant before relying on a patch measurement.
Related rule sources & dates
- AAP · KAS 3/6; Monitoring during phototherapy
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · Table 2 rows 1/2
Phototherapy to prevent severe neonatal hyperbilirubinemia: Technical report · August 26, 2024; September 2024 issue; supports the 2022 guideline
Source checked 2026-10-27
AAP: home phototherapy eligibility
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Already discharged · GA ≥38 weeks · age ≥48 h · Conditional option
Home LED phototherapy is an option only when all listed eligibility and access conditions are met: clinically well with adequate feeding, no neurotoxicity risks or previous phototherapy, TSB no more than 1 mg/dL above threshold, rapid device availability and daily TSB testing.
AAP threshold tables · published mg/dL values →
- All conditions apply together: GA ≥38 weeks, age ≥48 h, appropriate device quality, reliable family use and ability to measure TSB daily. Do not use if any of those are in doubt or any neurotoxicity risk is present.
- Check TSB daily. Admit for inpatient treatment if TSB increases and the gap to the treatment threshold narrows, or TSB is ≥1 mg/dL above threshold.
- Selected starting below threshold (for example 2 mg/dL below) is an option to reduce readmission, not a new universal threshold. In infants ≥7 days with persistent indirect bilirubin within 2 mg/dL of treatment threshold, fractionate total/direct bilirubin; home treatment is an option with applicable eligibility safeguards.
Related rule sources & dates
AAP: urgent exchange transfusion
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
At/above exchange threshold OR intermediate/advanced acute encephalopathy · Escalation
Perform urgent exchange for intermediate/advanced acute bilirubin encephalopathy signs, or TSB at/above the exchange threshold. Signs include hypertonia, arching, retrocollis, opisthotonos, high-pitched cry or recurrent apnea.
AAP permits bilirubin/albumin as an adjunct; NICE advises against using the albumin/bilirubin ratio for management. Do not combine these positions.
- Published adjunct thresholds, not calculated outputs.
AAP threshold tables · published mg/dL values →
- If TSB falls below exchange threshold while preparing, and no intermediate/advanced encephalopathy signs are present, exchange may be deferred while intensive phototherapy continues and TSB is checked every 2 h until below escalation threshold.
- AAP prefers crossmatched washed packed RBCs mixed with thawed adult fresh-frozen plasma to hematocrit about 40%. Exchange requires specialist capability.
- Bilirubin/albumin ratio may be used WITH TSB as an additional consideration, using TSB mg/dL and albumin g/dL; the table gives source values. It is not a replacement for TSB/encephalopathy criteria or an app calculation.
Related rule sources & dates
- AAP · KAS 22/23; Escalation discussion
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: IVIG is a conditional option
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
DAT-positive isoimmune hemolysis · TSB at/above escalation threshold · Conditional option
IVIG 0.5–1 g/kg over 2 h may be given for isoimmune hemolytic disease with a positive DAT when TSB reaches/exceeds escalation threshold; a repeat dose in 12 h is an option. Continue every other escalation intervention.
CPS limits consideration to settings where exchange cannot readily be performed. NICE specifies 500 mg/kg over 4 h with Rh/ABO hemolysis and rise >8.5 μmol/L/h. These are separate positions.
- Benefit in avoiding exchange is uncertain; observational data associate IVIG with NEC. Weigh response to intensive phototherapy, rise rate and timely exchange availability.
- The AAP FAQ describes the most favorable benefit–risk setting as isoimmune disease with exceeded escalation threshold and bilirubin continuing to rise despite intensive phototherapy. It does not make IVIG routine for every infant reaching escalation.
Related rule sources & dates
- AAP · KAS 21; FAQ IVIG question
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27 - AAP · FAQ: IVIG benefit and risk
Frequently asked questions about the 2022 AAP hyperbilirubinemia guideline · Updated July 17, 2025; implementation FAQ, not a new guideline
Source checked 2026-10-27
AAP: who needs closer jaundice surveillance?
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Birth hospitalization and follow-up · Risk factors
Assess GA, early jaundice, predischarge bilirubin near the phototherapy threshold, hemolysis, prior phototherapy, family history, feeding adequacy, bruising and other listed risks to identify infants needing closer monitoring.
AAP within-source difference: Table 1 uses > for rapid rise; KAS 7 uses ≥. The boundary is not resolved here.
- Table 1: each week below 40 weeks increases risk; jaundice <24 h; bilirubin close to threshold; known/suspected hemolysis; phototherapy before discharge; parent/sibling needing phototherapy or exchange; family history/genetic ancestry suggesting inherited RBC disorders/G6PD deficiency; exclusive breastfeeding with suboptimal intake; scalp hematoma/significant bruising; Down syndrome; macrosomic infant of a diabetic mother.
- These risks for developing high bilirubin are distinct from the neurotoxicity risks that change treatment thresholds. Table 1 uses rise >0.3 mg/dL/h before 24 h or >0.2 thereafter; KAS 7 uses ≥ at those boundaries.
Related rule sources & dates
- AAP · Table 1; Identifying risk factors
Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation · 2022 guideline; published August 5, 2022; September 2022 issue
Source checked 2026-10-27
AAP: when to screen bilirubin
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Visual assessment ≥every 12 h · measure at 24–48 h or earlier discharge · Screening
Assess jaundice visually at least every 12 h until discharge. If jaundice appears before 24 h, obtain TSB or TcB as soon as possible. Measure at least one TcB or TSB between 24 and 48 h, or before earlier discharge.
Screening differs by body: AAP measures all infants; NICE advises against routine bilirubin measurement without visible jaundice.
- Visual assessment supplements, rather than replaces, a bilirubin measurement. Home births also need measurement at 24–48 h.
- If needed outpatient bilirubin follow-up cannot be arranged, delaying discharge is an option. A spontaneous decline over ≥6 h without phototherapy generally needs no further measurement unless jaundice worsens or acute illness/other concerning signs occur.
Related rule sources & dates
AAP: predischarge follow-up planning
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Age ≥12 h · no phototherapy before discharge · Follow-up
Use the difference between the bilirubin measured closest to discharge and the contemporaneous phototherapy threshold to guide follow-up, with examination, feeding, weight, risk factors and family support. A discharge before age 12 h needs a bilirubin check at 24–48 h of age.
AAP threshold tables · published mg/dL values →
- KAS 24 / Figure 7 apply to infants ≥12 h who have not received phototherapy before discharge. The exact Figure 7 interval table has not been visually verified in this batch and is not reconstructed here; original guidance remains linked.
- The FAQ says the first 5 days in otherwise similar outpatients can generally use the birth-hospitalization approach with judgment; age >5 days needs additional clinical judgment. This is not an automatic repeat-testing timetable for every later visit.
- Before discharge give written/verbal jaundice education and written appointment date/time/place and bilirubin order/appointment when needed. Send last bilirubin, measurement age and DAT to the follow-up clinician; give this information to family if follow-up clinician is uncertain.
- Explain jaundice, dehydration, lethargy, ineffective feeding, fussiness/illness and follow-up; check understanding. Ensure weekend/holiday testing, results communication and a plan when follow-up is uncertain.
Related rule sources & dates
AAP: feeding support and jaundice
AAP · United States · Birth ≥35 weeks; hour-specific thresholds. Not guidance for <35 weeks.
Start breast milk in the first hour · ≥8 feeds/24 h · Supportive care
Provide breastfeeding support and frequent on-demand feeding, at least 8 times in 24 h. Assess urine, transitional stools, weight trajectory, maternal comfort and audible swallowing. Do not routinely supplement an adequately hydrated breastfed infant with formula.
AAP threshold tables · published mg/dL values →
- Do not give oral water or dextrose water to prevent or reduce hyperbilirubinemia. Discuss temporary donor milk/formula supplementation with parents, balancing benefits and breastfeeding/milk-supply effects.
- Maintain feeding during inpatient/home phototherapy. Brief breastfeeding interruptions are compatible with effective treatment, but minimize them near escalation threshold.
- Consider expressed milk, donor milk or formula as an alternative to readmission in a discharged breastfed infant with excess weight loss, history consistent with suboptimal intake and bilirubin approaching/at treatment threshold.
- IV fluid is not recommended unless dehydration cannot be corrected enterally or bilirubin exceeds the escalation threshold. Suboptimal-intake jaundice often peaks at days 3–5; persistent jaundice with adequate intake/weight gain is a different pattern.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
Conditions, related rules & sources for CPS: phototherapy thresholds and delivery
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: screening risk factors
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Assess at birth and at newborn visits
Identify risk for developing significant hyperbilirubinemia: GA <38 weeks, jaundice <24 h, evidence of hemolysis, phototherapy in the first 72 h, family history, suboptimal intake/excess weight loss, bruising/cephalohematoma and polycythemia.
Family risks include parent/sibling needing phototherapy or exchange and inherited RBC disorders causing hemolysis. Table 1a risks predict high bilirubin; Table 1b neurotoxicity risks determine treatment curves.
Conditions, related rules & sources for CPS: screening risk factors
- Perform a thorough examination within 24 h, assessing jaundice, risk factors, feeding, stools/voids and weight. Visual appearance alone is unreliable, especially with darker skin tones. Suspected significant jaundice at any age needs TSB/TcB without delay.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
Conditions, related rules & sources for CPS: neurotoxicity risks and curve choice
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: maternal antibody and newborn testing
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Prenatal screen; newborn tests if positive/unknown
Test maternal ABO/Rh type and red-cell antibodies during prenatal care; obtain missing results before delivery when possible. If antibody screen is positive or unknown at delivery, obtain newborn TSB, hemoglobin, reticulocytes, smear, DAT and blood group, preferably from cord blood.
Monitor these newborns for early jaundice <24 h. If a maternal antibody is known, initial testing also includes infant antigen testing for the corresponding antibody.
Conditions, related rules & sources for CPS: maternal antibody and newborn testing
- Universal DAT testing for all newborns, including all O-positive mothers’ infants, lacks sufficient evidence. DAT positivity alone does not prove or quantify hemolysis; RhIG can cause false positivity, and profound hemolysis/antibody clearance can cause false negativity. Interpret with hemoglobin, smear, reticulocytes and bilirubin.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
Conditions, related rules & sources for CPS: predischarge screening and repeat-test table
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Conditions, related rules & sources for CPS: confirm TcB with serum bilirubin
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
Conditions, related rules & sources for CPS: feeding, fluids and family-centered care
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS annex: home phototherapy criteria
CPS technical annex · Canada · Selected clinically stable infants born ≥38 weeks, age ≥48 h.
Birth ≥38 weeks · age ≥48 h · daily clinical/TSB checks
Consider home phototherapy only for selected low-risk infants with mild jaundice: birth ≥38 weeks, age ≥48 h, no previous phototherapy, no neurotoxicity risk and TSB no more than 15 μmol/L above phototherapy threshold. Daily clinical and TSB checks during AND after treatment are required.
CPS annex eligibility allows no more than 15 μmol/L above threshold while its readmission rule uses ≥15; preserve this overlap. AAP’s home criteria/readmission values use mg/dL and are separately labeled.
A safe program depends on community lactation, nursing and medical support, an available home device and access to blood sampling. Clinical stability must be assessed by the care provider.
Conditions, related rules & sources for CPS annex: home phototherapy criteria
- Readmit for intensive inpatient phototherapy if TSB keeps rising despite adequate home phototherapy, TSB is ≥15 μmol/L above threshold, OR rise is ≥5 μmol/L/h. The eligibility “no more than 15” and readmission “≥15” overlap at exactly 15; the source boundary is not resolved here.
- Annex scope wording is inconsistent: its title is ≥35 weeks, but repeated footers print ≤35 weeks. The home criteria themselves clearly require ≥38 weeks; do not extend them to <38 weeks from the footer.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
Conditions, related rules & sources for CPS: monitor and troubleshoot phototherapy
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
Conditions, related rules & sources for CPS: stop phototherapy and check for rebound
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: prolonged jaundice investigation
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Clinically significant jaundice >14 days
Investigate persistent clinically significant hyperbilirubinemia beyond 14 days for UTI, thyroid disease, hemolysis and inborn errors. Include the direct fraction to exclude pathologic cholestasis.
The statement defines clinically significant prolonged jaundice as TSB within 35 μmol/L of phototherapy threshold persisting >14 days in term/late-preterm infants. Direct bilirubin >17 μmol/L is abnormal.
Conditions, related rules & sources for CPS: prolonged jaundice investigation
- Promptly identifying cholestasis, including biliary atresia, matters; detailed cholestatic etiologies/treatment are outside this CPS statement. Do not substitute this definition for NICE’s different ≥37/<37-week timing.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
Conditions, related rules & sources for CPS: pre-exchange emergency protocol
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Conditions, related rules & sources for CPS: IVIG when exchange is not readily available
Source dates & verification
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
Conditions, related rules & sources for CPS: exchange transfusion and urgent signs
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
CPS: follow-up after significant jaundice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Hemoglobin 4–10 weeks · hearing and neurodevelopment referral
After immune hemolytic jaundice, arrange close follow-up and hemoglobin testing at 4–10 weeks for late anemia. Refer for formal audiology if peak TSB >400 μmol/L, pre-exchange threshold was reached/exceeded, or exchange was performed.
Refer for longitudinal neurodevelopmental follow-up if pre-exchange threshold was reached/exceeded, exchange occurred, or bilirubin-associated abnormal neurological signs occurred.
Conditions, related rules & sources for CPS: follow-up after significant jaundice
- After any treated jaundice, monitor until feeding/weight gain are established and TSB is falling; examine neurological status and hydration/nutrition. Late-anemia nadir is described at 4–6 weeks without exchange and 8–10 weeks with exchange.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CPS: pre-exchange emergency protocol
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At/above pre-exchange threshold: within 30 μmol/L below exchange · Escalation
At/above the pre-exchange threshold, start or continue intensive phototherapy and IV fluids, withhold enteral feeds and consult neonatology. Repeat TSB every 2–3 h and prepare transfer to an exchange-capable NICU.
- Send urgent total/direct bilirubin, CBC, albumin, chemistries, type/crossmatch and unfinished hemolysis work-up. Notify the blood bank to prepare exchange blood; continue light and supportive treatment during transfer.
- Figure 5: repeat TSB 2–3 h after starting/continuing intensive phototherapy, IV fluid and holding feeds. If it falls below pre-exchange threshold, discontinue the pre-exchange protocol but continue intensive phototherapy. If it remains ≥pre-exchange, admit/transfer to exchange-capable NICU, complete STAT labs/work-up and blood-bank preparation.
- While ≥pre-exchange but below exchange and without acute encephalopathy, continue intensive phototherapy/IV fluids and TSB every 2–3 h. If it drops below pre-exchange, exit that protocol but continue intensive phototherapy. At exchange threshold OR acute encephalopathy, perform urgent exchange.
- The source phrase “TSB ≤30 μmol/L below exchange” refers to the gap below the age/GA/risk-specific exchange threshold, not an absolute bilirubin ≤30 μmol/L.
Related rule sources & dates
CPS: neurotoxicity risks and curve choice
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA <38 weeks plus assessment for additional risks · Risk factors
CPS lists GA <38 weeks, albumin <30 g/L, suspected/diagnosed hemolysis, suspected/culture-proven sepsis, and significant hemodynamic or respiratory instability in the preceding 24 h as neurotoxicity risks.
- Use the GA-specific Figure 2 if GA is the only identified risk; Figure 3 applies with other neurotoxicity risks. Albumin is not a routine test in healthy infants, but may be warranted in critical illness or severe bilirubin nearing/surpassing pre-exchange threshold.
- Hemolysis may be suspected with a rise ≥5 μmol/L/h in the first 24 h or ≥3.5 μmol/L/h after 24 h. These are CPS’s source units/values, not app conversions.
Related rule sources & dates
CPS: exchange transfusion and urgent signs
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
At exchange threshold OR acute bilirubin encephalopathy · Escalation
Perform urgent double-volume exchange if TSB reaches the GA/hour/risk-specific exchange threshold OR acute bilirubin encephalopathy signs appear. With neurotoxicity risks, exchange may be initiated already at pre-exchange threshold.
- Signs include hypertonia, opisthotonus/retrocollis, high-pitched cry, fever, irritability/stupor, seizures, coma or apnea. Specialist expertise, equipment and resources are required.
- If the first measured TSB is already at/above exchange threshold, urgently initiate intensive phototherapy/IV fluids and repeat TSB in 2–3 h to assess whether exchange remains necessary; clinical encephalopathy still mandates urgent exchange.
- Restart intensive phototherapy after exchange and monitor TSB by the pre-exchange protocol. Risks include cardiorespiratory/catheter complications, hypoglycemia/electrolyte disturbances, thrombocytopenia/coagulopathy and NEC.
- Within-source wording: main Recommendation 26/Box 1 use within ≤30 μmol/L below exchange; technical-annex p3 comparison text instead prints “TSB ≥30 μmol/L of” exchange threshold. The annex wording is not silently substituted for the main clinical recommendation.
Related rule sources & dates
CPS: IVIG when exchange is not readily available
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Isoimmune hemolytic disease · pre-exchange threshold reached · Conditional option
If exchange transfusion cannot readily be performed, consider IVIG 0.5–1.0 g/kg over 2 h for isoimmune hemolytic disease with TSB at pre-exchange threshold. A repeat dose at 12 h is an option.
CPS adds the condition that exchange cannot readily be performed; AAP and NICE have different IVIG criteria and timing.
- Do not routinely use IVIG for severe Rh/ABO antibody-mediated hemolytic jaundice; trials give conflicting evidence of exchange benefit. Continue emergency treatment and exchange preparation.
Related rule sources & dates
- CPS · Recommendation 24; IVIG; Figure 5
Detection and management of hyperbilirubinemia in term and late preterm newborns (≥35 weeks) · March 18, 2025; addendum December 18, 2025
Source checked 2026-10-27
CPS: monitor and troubleshoot phototherapy
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Initial TSB 12–24 h · abnormal rise/nonresponse every 4–6 h · Monitoring
Check TSB within 12–24 h after starting inpatient phototherapy, then according to age, risks and trajectory. If TSB rises or fails to respond, check effective light delivery, investigate hemolysis/other causes and measure TSB at least every 4–6 h.
Figure 4 uses ≥30/≥60 μmol/L below threshold for stopping; Recommendation 16 and narrative use >30/>60. Preserve the boundary difference rather than silently choosing one.
- Figure 4: if the repeat value is not lower, check adequate irradiance, distance, exposed skin and interruptions. If delivery is inadequate, correct it, continue treatment and repeat TSB ≤12 h. If already adequate, continue intensive treatment, do hemolysis work-up, sepsis testing when indicated, and repeat in 4–6 h.
- If the TSB reaches pre-exchange threshold, proceed to the emergency pre-exchange protocol. If lower and below escalation, continue treatment toward the stopping criterion. Age/risk/trajectory can warrant more frequent monitoring than the routine initial interval.
- Possible tests: CBC, reticulocytes, smear, DAT, G6PD/pyruvate kinase assays; sepsis/UTI evaluation and rare-antibody work-up as indicated. Hemolysis is suspected with ≥5 μmol/L/h before 24 h or ≥3.5 afterward. Serial trajectory samples are described as ≥3 h apart.
- Consider G6PD with persistent jaundice, no risk factors or nonresponse; an active hemolysis assay may be falsely normal. Repeat at 3 months if suspicion persists.
Related rule sources & dates
CPS: stop phototherapy and check for rebound
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
GA ≥38 versus 35–37 weeks · Monitoring
Recommendation 16 says stop at ΔTSB >30 μmol/L for GA ≥38 weeks, or >60 μmol/L for GA 35–37 weeks. Recheck TSB 12–24 h after stopping; high-risk infants, such as hemolytic disease, need 6–12 h follow-up and then every 24 h.
CPS TcB rebound interval is ≥18 h; AAP says ≥24 h. CPS’s Box 1/Recommendation 16/Figure 4 boundary and GA wording differences remain unresolved.
- For high-risk infants, continue follow-up until TSB trends down and ΔTSB is well above 60 μmol/L. TcB can be used only after ≥18 h off phototherapy.
- Rebound is reaching the treatment threshold within 72–96 h of stopping. GA <38 weeks, treatment beginning <48 h and the stopping gap predict rebound.
- Unresolved within-source wording: Box 1’s third rule says 35–38 weeks for >60, overlapping its ≥38 rule; Recommendation 16/narrative say 35–37. Figure 4 uses ≥30/≥60 where Recommendation 16 says >30/>60.
Related rule sources & dates
CPS: phototherapy thresholds and delivery
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Birth ≥35 weeks · hour-specific treatment curves · Treatment
Provide intensive phototherapy when TSB reaches the GA-, neurotoxicity-risk- and hour-specific threshold. With additional neurotoxicity risks, consider starting within 30 μmol/L below the threshold.
- Use narrow-spectrum light around 460–490 nm with irradiance ≥30 μW/cm²/nm. Check devices regularly with a radiometer; a second light/pad can increase exposed area without necessarily increasing irradiance.
- Use the GA-specific no-additional-risk graph when GA is the only neurotoxicity risk. Use the additional-risk graph for other risks. CPS’s treatment curves are AAP-provided data in μmol/L; the app does not independently convert or digitize those curves.
- Original CPS curves remain available through the supporting link. The locally published AAP grids use mg/dL and must not be mislabeled as CPS μmol/L tables.
Related rule sources & dates
CPS: feeding, fluids and family-centered care
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Until feeding is established and during treatment · Supportive care
Make breastfeeding support accessible until feeding is established. Assess feeding effectiveness, weight, urine/stools, and support early skin-to-skin contact. With suitable presentation/severity, use a fiberoptic pad/blanket to support breastfeeding and skin-to-skin care during treatment.
- In mild hyperbilirubinemia, brief breaks of 20–30 min, 8–10 times/day, can be considered. These are not interruptions for an infant needing uninterrupted escalation care.
- Increase enteral intake, including gavage when appropriate. Reserve supplemental IV fluids for severe dehydration or high exchange risk; pre-exchange protocol is a separate emergency setting.
- Provide first-language-concordant written/verbal jaundice information, timed screen values, ΔTSB/interpretation and next steps. Ensure community support and timely bilirubin measurement/treatment after discharge.
Related rule sources & dates
CPS: predischarge screening and repeat-test table
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Screen ≥12 h · Figure 1 age range 12–120 h · Screening
Measure predischarge TSB or TcB in all newborns at ≥12 h. If below treatment threshold, use ΔTSB (threshold minus measured bilirubin) and the published table for discharge/retesting. At or above threshold, begin treatment.
- ΔTSB is the phototherapy threshold minus measured bilirubin. This table applies to the algorithm’s 12–120-hour population with no prior phototherapy, not all later follow-up visits.
- If no concern for early jaundice, sampling with the newborn metabolic screen can reduce painful procedures. Arrange screening for home birth or discharge before 12 h.
- Confirm TcB with TSB when within 50 μmol/L of treatment threshold OR above 250 μmol/L. GA-only risk uses the GA-specific no-additional-risk threshold.
- December 2025 addendum: Figure 1 guides predischarge/first post-discharge follow-up from 12–120 h data. Subsequent outpatient sampling needs clinical judgment based on age, condition, rise, hemolysis and ΔTSB trend; do not automatically repeat this table indefinitely.
Related rule sources & dates
CPS: confirm TcB with serum bilirubin
CPS · Canada · Term and late-preterm newborns born ≥35 weeks.
Within 50 μmol/L of phototherapy threshold OR TcB >250 μmol/L · Screening
Obtain confirmatory TSB when TcB is within 50 μmol/L of the hour-specific treatment threshold or is above 250 μmol/L. Check new TcB devices against laboratory serum samples before clinical deployment and calibrate periodically.
- Inter-device variation can be substantial; the statement describes applying a discovered bias correction before plotting against a threshold. This app does not calculate such corrections.
Related rule sources & dates
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
Conditions, related rules & sources for NICE: treatment threshold table for ≥38 weeks
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: assess jaundice and screen by appearance
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Every opportunity, especially first 72 h; extra inspection in first 48 h if at risk
Assess risk soon after birth and look for jaundice at every opportunity, especially in the first 72 h. Risks include GA <38 weeks, a sibling who needed phototherapy, intended exclusive breastfeeding and visible jaundice in the first 24 h.
NICE’s no-routine-test-without-visible-jaundice position differs from AAP/CPS universal predischarge measurement.
Give at-risk infants an additional professional visual inspection in the first 48 h. Support exclusive breastfeeding. Examine the naked infant in bright, preferably natural light; look at sclerae/gums and blanched skin. Skin color change is harder to detect in darker skin.
Conditions, related rules & sources for NICE: assess jaundice and screen by appearance
- Do not estimate bilirubin from appearance alone when jaundice is suspected. Do not routinely measure bilirubin in infants who are not visibly jaundiced.
- Do not use cord bilirubin, ETCOc or cord DAT to predict significant hyperbilirubinemia. This prediction restriction is distinct from diagnostic DAT in established jaundice.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: jaundice in the first 24 hours
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Serum bilirubin within 2 h · urgent medical review within 6 h · Screening
For suspected/obvious jaundice before 24 h, measure and record serum bilirubin within 2 h, repeat every 6 h until below treatment threshold AND stable/falling, and arrange medical review as soon as possible and within 6 h to exclude pathological causes.
- Interpret the result by postnatal hours and the appropriate threshold table/graphs. Serum testing, rather than TcB, is required in the first 24 h and at any age with GA <35 weeks.
Related rule sources & dates
- NICE · 1.2.10–1.2.13; 1.2.15
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: bilirubin testing after 24 hours
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Suspected/obvious jaundice >24 h: measure within 6 h · Screening
Measure bilirubin within 6 h for suspected/obvious jaundice after 24 h. At GA ≥35 weeks and age >24 h use TcB, or serum if TcB is unavailable. Confirm with serum if TcB >250 μmol/L.
- Use serum at/above treatment threshold and for all subsequent measurements. Use serum for GA <35 weeks or in the first 24 h. Do not use an icterometer.
Related rule sources & dates
- NICE · 1.2.14–1.2.17
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: assess underlying disease
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Significant hyperbilirubinemia · Investigation
Alongside a full clinical examination, obtain baseline serum bilirubin, packed cell volume, maternal/infant blood groups and DAT. Interpret DAT strength and maternal prophylactic anti-D.
- Consider CBC/film, G6PD testing taking ancestry into account, and blood/urine/CSF cultures if infection is suspected, according to clinical indication.
Related rule sources & dates
- NICE · 1.6.1–1.6.2
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: jaundice in the first 24 hours
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Serum bilirubin within 2 h · urgent medical review within 6 h
For suspected/obvious jaundice before 24 h, measure and record serum bilirubin within 2 h, repeat every 6 h until below treatment threshold AND stable/falling, and arrange medical review as soon as possible and within 6 h to exclude pathological causes.
Interpret the result by postnatal hours and the appropriate threshold table/graphs. Serum testing, rather than TcB, is required in the first 24 h and at any age with GA <35 weeks.
Conditions, related rules & sources for NICE: jaundice in the first 24 hours
Source dates & verification
- NICE · 1.2.10–1.2.13; 1.2.15
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: assess underlying disease
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Significant hyperbilirubinemia · Investigation
Alongside a full clinical examination, obtain baseline serum bilirubin, packed cell volume, maternal/infant blood groups and DAT. Interpret DAT strength and maternal prophylactic anti-D.
- Consider CBC/film, G6PD testing taking ancestry into account, and blood/urine/CSF cultures if infection is suspected, according to clinical indication.
Related rule sources & dates
- NICE · 1.6.1–1.6.2
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: bilirubin testing after 24 hours
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Suspected/obvious jaundice >24 h: measure within 6 h
Measure bilirubin within 6 h for suspected/obvious jaundice after 24 h. At GA ≥35 weeks and age >24 h use TcB, or serum if TcB is unavailable. Confirm with serum if TcB >250 μmol/L.
Use serum at/above treatment threshold and for all subsequent measurements. Use serum for GA <35 weeks or in the first 24 h. Do not use an icterometer.
Conditions, related rules & sources for NICE: bilirubin testing after 24 hours
Source dates & verification
- NICE · 1.2.14–1.2.17
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: repeat testing below phototherapy threshold
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Clinically well · GA ≥38 weeks · age >24 h
If bilirubin is below but within 50 μmol/L of phototherapy threshold, repeat within 18 h with specified risk factors, or within 24 h without them. If more than 50 μmol/L below threshold, do not routinely repeat.
The specified risks for the 18-hour interval are a sibling who needed phototherapy or intention to exclusively breastfeed. These intervals apply only to the clinically well ≥38-week, >24-hour group.
Conditions, related rules & sources for NICE: repeat testing below phototherapy threshold
- Do not give phototherapy below/not exceeding the NICE threshold. This differs from selected subthreshold options described by AAP/CPS.
Source dates & verification
- NICE · 1.4.1–1.4.3
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Conditions, related rules & sources for NICE: monitoring, stopping and rebound
Source dates & verification
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
Conditions, related rules & sources for NICE: when to intensify phototherapy
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Source dates & verification
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
Conditions, related rules & sources for NICE: feeding and care during phototherapy
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Source dates & verification
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: assess underlying disease
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Significant hyperbilirubinemia
Alongside a full clinical examination, obtain baseline serum bilirubin, packed cell volume, maternal/infant blood groups and DAT. Interpret DAT strength and maternal prophylactic anti-D.
Consider CBC/film, G6PD testing taking ancestry into account, and blood/urine/CSF cultures if infection is suspected, according to clinical indication.
Conditions, related rules & sources for NICE: assess underlying disease
Source dates & verification
- NICE · 1.6.1–1.6.2
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: prolonged jaundice and conjugated bilirubin
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥37 weeks: >14 days · GA <37 weeks: >21 days
Check for pale chalky stools/dark urine, measure conjugated bilirubin, obtain CBC and maternal/infant groups/DAT, and ensure metabolic screening including congenital hypothyroidism is complete. Consider urine culture only with clinical suspicion of UTI.
NICE prolonged-jaundice ages/direct thresholds differ from AAP and CPS. Keep GA and assay/source context.
The urine-culture condition is the October 2023 update; it is not a routine urine culture for every prolonged-jaundice infant.
More conditions & sources (1) for NICE: prolonged jaundice and conjugated bilirubin
- Follow expert advice if conjugated bilirubin >25 μmol/L because serious liver disease is possible. Interpret DAT with its strength and maternal anti-D history.
Source dates & verification
NICE: IVIG for Rh/ABO hemolytic disease
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Bilirubin continuing to rise >8.5 μmol/L/h
Use IVIG 500 mg/kg over 4 h as an adjunct to continuous intensified phototherapy for rhesus or ABO hemolytic disease when serum bilirubin continues rising >8.5 μmol/L/h.
NICE’s 4-hour regimen and rise criterion differ from AAP/CPS’s 2-hour conditional options. No consensus dosing rule is inferred.
Explain why IVIG is being considered/needed, possible adverse effects, and when caregivers can see/hold their infant. This is NICE’s source-specific regimen and criterion.
Conditions, related rules & sources for NICE: IVIG for Rh/ABO hemolytic disease
Source dates & verification
- NICE · 1.8.1–1.8.2
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
Conditions, related rules & sources for NICE: exchange transfusion and post-exchange care
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Source dates & verification
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: explain jaundice and treatment to families
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Before and during treatment
Use discussion plus written information tailored to family concerns: jaundice risks/recognition, urgent advice for first-day jaundice, dark urine/pale stools, likely course and usual ability to continue breastfeeding.
Discuss treatment duration and feeding/nappy/cuddle opportunities, phototherapy reasons/benefits, adverse effects including uncertain longer-term concerns, eye care, breaks, possible treatment failure/rebound and protecting breastfeeding. Avoid unnecessary anxiety.
Conditions, related rules & sources for NICE: explain jaundice and treatment to families
Source dates & verification
- NICE · 1.1.1; 1.3.1; 1.4.11
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
NICE: jaundice in the first 24 hours
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Serum bilirubin within 2 h · urgent medical review within 6 h · Screening
For suspected/obvious jaundice before 24 h, measure and record serum bilirubin within 2 h, repeat every 6 h until below treatment threshold AND stable/falling, and arrange medical review as soon as possible and within 6 h to exclude pathological causes.
- Interpret the result by postnatal hours and the appropriate threshold table/graphs. Serum testing, rather than TcB, is required in the first 24 h and at any age with GA <35 weeks.
Related rule sources & dates
- NICE · 1.2.10–1.2.13; 1.2.15
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: feeding and care during phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Routine versus intensified treatment · Supportive care
Maximize exposed skin, use supine positioning unless another clinical condition prevents it, monitor temperature in a thermoneutral environment, and assess hydration with daily weight and wet nappies. Provide eye protection and routine eye care.
- For GA ≥37 weeks, tinted headboxes are an alternative to eye protection. Choose incubator/bassinet by clinical need/availability. Maintain equipment per manufacturer; do not routinely use white curtains that impede observation.
- During routine phototherapy, use judgment to allow breaks up to 30 min for breastfeeding, nappy changes and cuddles; support lactation. NICE says no additional fluids for breastfed infants; when additional feeds are indicated, maternal expressed milk is preferred if available.
- During intensified phototherapy, do not interrupt light for feeding; continue IV/enteral feeds and lactation support. Encourage frequent breastfeeding and wake for feeds when necessary outside that uninterrupted treatment setting.
Related rule sources & dates
- NICE · 1.3.2/1.3.3; 1.4.12–1.4.19
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: treatment threshold table for ≥38 weeks
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
GA ≥38 weeks · TSB μmol/L · published age points · Thresholds
Use postnatal age in hours and the appropriate GA-specific threshold. For ≥38 weeks, the table gives NICE’s published phototherapy and exchange cutoffs. Do not subtract conjugated bilirubin or use the albumin/bilirubin ratio for management.
NICE does not use the bilirubin/albumin ratio; AAP allows it as an exchange adjunct. Thresholds and populations must remain body-specific.
- Strict > signs are from the source. Consult laboratory about assay variation. No interpolated values are generated.
- The table’s > signs are retained. NICE says not to give phototherapy when bilirubin does not exceed the phototherapy threshold. Exchange may be avoided if bilirubin falls below its threshold during preparation, subject to the separate encephalopathy indication.
- Assays vary between manufacturers: consult the local pathology laboratory when interpreting thresholds. These are fixed source values, not interpolation, unit conversion or patient-specific advice.
- This numeric table does not cover GA <38 weeks. The linked official treatment graphs cover additional gestations; their numeric data are not yet extracted locally. Do not apply the ≥38-week table to more premature infants.
Related rule sources & dates
NICE: assess underlying disease
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Significant hyperbilirubinemia · Investigation
Alongside a full clinical examination, obtain baseline serum bilirubin, packed cell volume, maternal/infant blood groups and DAT. Interpret DAT strength and maternal prophylactic anti-D.
- Consider CBC/film, G6PD testing taking ancestry into account, and blood/urine/CSF cultures if infection is suspected, according to clinical indication.
Related rule sources & dates
- NICE · 1.6.1–1.6.2
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: when to intensify phototherapy
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Any listed trigger; source-specific hour/threshold limits · Escalation
Consider intensified phototherapy if bilirubin rises >8.5 μmol/L/h, is within 50 μmol/L below exchange threshold at age ≥72 h, or fails to fall/continues rising within 6 h of initial phototherapy.
- Intensify by adding a source or increasing appropriate-spectrum irradiance. If bilirubin falls to 50 μmol/L below exchange threshold during intensified treatment, reduce intensity.
- Use artificial phototherapy with appropriate spectrum/irradiance, not sunlight. Use the applicable threshold graph/table. A >340 μmol/L TSB at GA ≥37 weeks, rise >8.5 μmol/L/h or clinical acute encephalopathy marks increased kernicterus risk.
Related rule sources & dates
- NICE · 1.4.7–1.4.10; 1.5.1
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: exchange transfusion and post-exchange care
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Threshold indicates exchange and/or acute encephalopathy · Escalation
Use double-volume exchange when bilirubin thresholds indicate it and/or acute bilirubin encephalopathy is present. Continue intensified phototherapy during and after exchange; check serum bilirubin within 2 h afterward and manage against thresholds.
- Do not use single-volume exchange, albumin priming or routine IV calcium during exchange. Explain intensive-care admission, indication, adverse effects and when caregivers can see/hold their infant.
- The threshold-table preparation exception permits deferring exchange if bilirubin falls below threshold while preparing; this does not erase the independent encephalopathy indication.
Related rule sources & dates
- NICE · 1.9.1–1.9.4; threshold table
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: monitoring, stopping and rebound
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
TSB 4–6 h after starting; then every 6–12 h when stable/falling · Monitoring
Repeat serum bilirubin 4–6 h after starting phototherapy, then every 6–12 h once stable/falling. Stop once TSB is at least 50 μmol/L below phototherapy threshold; check serum bilirubin 12–18 h later for rebound.
NICE stopping/rebound rules differ from AAP starting-threshold-based stopping and CPS’s GA-specific gaps; do not mix them.
- The rebound test does not necessarily require continued hospitalization. Use the appropriate GA-specific threshold, not the ≥38-week table for every infant.
Related rule sources & dates
- NICE · 1.4.4–1.4.6
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
NICE: therapies not recommended
NICE · United Kingdom · Newborns under 28 days, including preterm; table-specific GA limits apply.
Hyperbilirubinemia treatment
Do not use agar, albumin, barbiturates, charcoal, cholestyramine, clofibrate, D-penicillamine, glycerin, manna, metalloporphyrins, riboflavin, traditional Chinese medicine, acupuncture or homeopathy to treat hyperbilirubinemia.
NICE also says not to use sunlight. This is its treatment recommendation, not a statement that every named substance has no use in any other neonatal condition.
Source details & dates for NICE: therapies not recommended
Source dates & verification
- NICE · 1.10.1; 1.4.7
CG98: Jaundice in newborn babies under 28 days · May 19, 2010; updated October 31, 2023; official current PDF checked
Source checked 2026-10-27
CLABSI: routine gloves for every contact?
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Beyond usual hand hygiene and indicated PPE
CDC does not resolve whether adding nonsterile gloves after hand hygiene before every NICU patient contact prevents CLABSI better than hand hygiene alone.
This is not a recommendation to omit hand hygiene or gloves that are indicated by Standard or Contact Precautions. Those indications are available in the local related guidance.
Conditions, related rules & sources for CLABSI: routine gloves for every contact?
- Evidence confidence: moderate, with imprecision. The one trial in a selected preterm population did not establish a universal routine-gloving policy for all NICU contacts.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: select catheter and insertion site by clinical need
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Before choosing central vascular access
Choose catheter type and its appropriate insertion site based on clinical needs; do not choose either solely for CLABSI prevention.
Consider chronologic/gestational age, size, congenital abnormalities, prior devices, expected duration and available access/expertise. The guideline does not establish one universally safest catheter type or site.
Conditions, related rules & sources for CLABSI: select catheter and insertion site by clinical need
- Available sites can be limited; repeated attempts and mechanical complications matter. Femoral access can present maintenance challenges in diapered infants.
- Evidence confidence: very low for catheter type; low for site selection. Findings on infection and other complications are inconsistent and confounded by patient need.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: use the fewest lumens needed
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Match lumen count to clinical requirements · Conditional recommendation
Consider the fewest catheter lumens that meet the NICU patient’s clinical needs.
- This is conditional, not a requirement to use one lumen regardless of care needs. Evidence confidence is low; the comparison can be confounded because infants needing more complex care may need more access.
Related rule sources & dates
- CDC · Recommendation 4
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Conditional recommendation
CLABSI: use the fewest lumens needed
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Match lumen count to clinical requirements
Consider the fewest catheter lumens that meet the NICU patient’s clinical needs.
This is conditional, not a requirement to use one lumen regardless of care needs. Evidence confidence is low; the comparison can be confounded because infants needing more complex care may need more access.
Conditions, related rules & sources for CLABSI: use the fewest lumens needed
Source dates & verification
- CDC · Recommendation 4
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: select catheter and insertion site by clinical need
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Before choosing central vascular access · Recommendation
Choose catheter type and its appropriate insertion site based on clinical needs; do not choose either solely for CLABSI prevention.
- Consider chronologic/gestational age, size, congenital abnormalities, prior devices, expected duration and available access/expertise. The guideline does not establish one universally safest catheter type or site.
- Available sites can be limited; repeated attempts and mechanical complications matter. Femoral access can present maintenance challenges in diapered infants.
- Evidence confidence: very low for catheter type; low for site selection. Findings on infection and other complications are inconsistent and confounded by patient need.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Conditional recommendation
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
Conditions, related rules & sources for CLABSI: alcohol-containing chlorhexidine skin antisepsis
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Conditional recommendation
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
Conditions, related rules & sources for CLABSI: chlorhexidine bathing and its limits
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Conditions, related rules & sources for CLABSI: minimize hub access and central-line sampling
Source dates & verification
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Conditional recommendation
CLABSI: antimicrobial locks are a conditional additional measure
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Ongoing CLABSI in the unit, in addition to core prevention
Consider central-line antimicrobial locks when a NICU has ongoing CLABSIs, in addition to core infection-prevention measures—not as a substitute for insertion and maintenance practices.
Some infants need continuous infusions that cannot be interrupted and are exceptions to this approach. Locks interrupt fluid delivery; reported harms include hypoglycemia, product-related adverse effects and possible antimicrobial resistance.
Conditions, related rules & sources for CLABSI: antimicrobial locks are a conditional additional measure
- No antimicrobial agent, dose, lock duration or universal regimen is specified. Facilities may use their antibiogram and causative organisms when selecting an agent; catheter compatibility also matters.
- Evidence confidence: high, but indirectness limits applicability to current practice. All three trials had high baseline infection rates; benefit in units with much lower modern rates is less certain.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
UAC and UVC: removal and longer-term access
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Remove promptly when no longer needed; conditional ≤7-day options
Remove umbilical arterial and venous catheters as soon as possible when no longer needed. CDC’s 2022 NICU guideline conditionally suggests considering UAC or UVC removal at or before 7 days of dwell time.
For infants needing long-term central venous access, consider removing the UVC and placing a PICC or other long-term central venous catheter at or before 7 days of UVC dwell time. This is a conditional option, not an automatic patient-specific replacement order.
- Remove UAC/UVC promptly when no longer needed regardless of these conditional time points. These are dwell days, not postnatal-age thresholds.
Conditions, related rules & sources for UAC and UVC: removal and longer-term access
- No optimal exact removal day was established; balance dwell time and infection risk with clinical access needs. Evidence confidence by CDC recommendation: 9.a (prompt UAC/UVC removal), very low; 9.b (UAC at or before 7 dwell days), low; 9.c (UVC at or before 7 dwell days), very low; 9.d (UVC-to-long-term access at or before 7 dwell days), low. Recommendations 9.b–9.d are conditional.
- Dwell time means time the catheter has been in place, not the infant’s age. The older CDC general-catheter source has different umbilical time statements; both document-specific positions are shown locally.
Source dates & verification
- CDC · Recommendations 9.a–9.d
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27 - CDC · Sections16.7–16.9: differing older general time statements
Prevention of intravascular catheter-related infections: selected baseline sections · 2011 general catheter guideline; web summary February 28, 2024; selected prerequisite/comparison material, not full extraction
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: select catheter and insertion site by clinical need
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Before choosing central vascular access · Recommendation
Choose catheter type and its appropriate insertion site based on clinical needs; do not choose either solely for CLABSI prevention.
- Consider chronologic/gestational age, size, congenital abnormalities, prior devices, expected duration and available access/expertise. The guideline does not establish one universally safest catheter type or site.
- Available sites can be limited; repeated attempts and mechanical complications matter. Femoral access can present maintenance challenges in diapered infants.
- Evidence confidence: very low for catheter type; low for site selection. Findings on infection and other complications are inconsistent and confounded by patient need.
Related rule sources & dates
PICC: remove when unneeded; routine prolonged-line replacement unresolved
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Ongoing clinical need versus unnecessary dwell time · Recommendation
Remove a PICC as soon as possible when no longer needed. If central access is still required, CDC’s 2022 NICU guideline does not resolve whether a long-standing PICC should be removed and replaced solely to prevent CLABSI.
- No specific PICC day was established at which infection risk changes enough to prescribe routine replacement. Evidence confidence: very low. Do not apply the umbilical catheter’s 7-day conditional option to a PICC.
- The older general CDC catheter guidance says not to routinely replace CVCs/PICCs solely to prevent infection. Its separate source/version is provided locally; the NICU statement’s unresolved status remains explicit.
Related rule sources & dates
CDC catheter timing: older general guidance differs from NICU 2022
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
2011 general catheter statement versus 2022 NICU-specific options · Source difference
The older CDC general catheter guidance says UACs optimally should not remain >5 days and UVCs may be used up to 14 days if managed aseptically, with prompt removal when unneeded. The 2022 NICU guideline instead conditionally suggests considering removal of either by 7 dwell days.
Within CDC: 2011 general UAC≤5/UVC≤14 statements and 2022 NICU conditional ≤7-day options differ. They retain their own scope/category and are not silently reconciled.
- These are different source documents and categories, not one merged cutoff. The app does not resolve clinical precedence from the publication date; use the exact source and applicable approved policy.
- The 2011 general guideline also says not to routinely replace CVCs/PICCs solely for infection prevention. The 2022 NICU chapter specifically leaves replacement of a prolonged PICC with ongoing access need unresolved.
- For umbilical malfunction, the older statement allows replacement only with no other removal indication and within its total 5-day UAC/14-day UVC duration; this does not erase infection/thrombosis/vascular-insufficiency removal indications in that older source. No patient replacement decision is calculated here.
- The older umbilical time statements are Category II; the 2022 NICU ≤7-day options are Conditional Recommendations. Publication dates alone do not settle this source difference.
Related rule sources & dates
CLABSI: use the fewest lumens needed
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Match lumen count to clinical requirements · Conditional recommendation
Consider the fewest catheter lumens that meet the NICU patient’s clinical needs.
- This is conditional, not a requirement to use one lumen regardless of care needs. Evidence confidence is low; the comparison can be confounded because infants needing more complex care may need more access.
Related rule sources & dates
- CDC · Recommendation 4
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
PICC: remove when unneeded; routine prolonged-line replacement unresolved
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Ongoing clinical need versus unnecessary dwell time
Remove a PICC as soon as possible when no longer needed. If central access is still required, CDC’s 2022 NICU guideline does not resolve whether a long-standing PICC should be removed and replaced solely to prevent CLABSI.
No specific PICC day was established at which infection risk changes enough to prescribe routine replacement. Evidence confidence: very low. Do not apply the umbilical catheter’s 7-day conditional option to a PICC.
Conditions, related rules & sources for PICC: remove when unneeded; routine prolonged-line replacement unresolved
- The older general CDC catheter guidance says not to routinely replace CVCs/PICCs solely to prevent infection. Its separate source/version is provided locally; the NICU statement’s unresolved status remains explicit.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CDC catheter timing: older general guidance differs from NICU 2022
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
2011 general catheter statement versus 2022 NICU-specific options · Source difference
The older CDC general catheter guidance says UACs optimally should not remain >5 days and UVCs may be used up to 14 days if managed aseptically, with prompt removal when unneeded. The 2022 NICU guideline instead conditionally suggests considering removal of either by 7 dwell days.
Within CDC: 2011 general UAC≤5/UVC≤14 statements and 2022 NICU conditional ≤7-day options differ. They retain their own scope/category and are not silently reconciled.
- These are different source documents and categories, not one merged cutoff. The app does not resolve clinical precedence from the publication date; use the exact source and applicable approved policy.
- The 2011 general guideline also says not to routinely replace CVCs/PICCs solely for infection prevention. The 2022 NICU chapter specifically leaves replacement of a prolonged PICC with ongoing access need unresolved.
- For umbilical malfunction, the older statement allows replacement only with no other removal indication and within its total 5-day UAC/14-day UVC duration; this does not erase infection/thrombosis/vascular-insufficiency removal indications in that older source. No patient replacement decision is calculated here.
- The older umbilical time statements are Category II; the 2022 NICU ≤7-day options are Conditional Recommendations. Publication dates alone do not settle this source difference.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
UAC and UVC: removal and longer-term access
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Remove promptly when no longer needed; conditional ≤7-day options · Recommendation
Remove umbilical arterial and venous catheters as soon as possible when no longer needed. CDC’s 2022 NICU guideline conditionally suggests considering UAC or UVC removal at or before 7 days of dwell time.
- Remove UAC/UVC promptly when no longer needed regardless of these conditional time points. These are dwell days, not postnatal-age thresholds.
- For infants needing long-term central venous access, consider removing the UVC and placing a PICC or other long-term central venous catheter at or before 7 days of UVC dwell time. This is a conditional option, not an automatic patient-specific replacement order.
- No optimal exact removal day was established; balance dwell time and infection risk with clinical access needs. Evidence confidence by CDC recommendation: 9.a (prompt UAC/UVC removal), very low; 9.b (UAC at or before 7 dwell days), low; 9.c (UVC at or before 7 dwell days), very low; 9.d (UVC-to-long-term access at or before 7 dwell days), low. Recommendations 9.b–9.d are conditional.
- Dwell time means time the catheter has been in place, not the infant’s age. The older CDC general-catheter source has different umbilical time statements; both document-specific positions are shown locally.
Related rule sources & dates
- CDC · Recommendations 9.a–9.d
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27 - CDC · Sections16.7–16.9: differing older general time statements
Prevention of intravascular catheter-related infections: selected baseline sections · 2011 general catheter guideline; web summary February 28, 2024; selected prerequisite/comparison material, not full extraction
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: select catheter and insertion site by clinical need
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Before choosing central vascular access · Recommendation
Choose catheter type and its appropriate insertion site based on clinical needs; do not choose either solely for CLABSI prevention.
- Consider chronologic/gestational age, size, congenital abnormalities, prior devices, expected duration and available access/expertise. The guideline does not establish one universally safest catheter type or site.
- Available sites can be limited; repeated attempts and mechanical complications matter. Femoral access can present maintenance challenges in diapered infants.
- Evidence confidence: very low for catheter type; low for site selection. Findings on infection and other complications are inconsistent and confounded by patient need.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use the fewest lumens needed
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Match lumen count to clinical requirements · Conditional recommendation
Consider the fewest catheter lumens that meet the NICU patient’s clinical needs.
- This is conditional, not a requirement to use one lumen regardless of care needs. Evidence confidence is low; the comparison can be confounded because infants needing more complex care may need more access.
Related rule sources & dates
- CDC · Recommendation 4
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Conditional recommendation
CLABSI: consider a dedicated catheter-care team
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Unit-level prevention program
Consider a dedicated catheter-care team to prevent CLABSI in NICU patients.
CDC does not specify team composition or assigned duties; facilities must define them. Evidence confidence: very low. A team complements, rather than replaces, competent insertion/maintenance practices and appropriate staffing.
Conditions, related rules & sources for CLABSI: consider a dedicated catheter-care team
Source dates & verification
- CDC · Recommendation 11
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
Conditions, related rules & sources for CLABSI: use insertion and maintenance bundles
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: no routine prophylactic antimicrobial infusions
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Prevention-only systemic infusions
Do not routinely use prophylactic antimicrobial infusions to reduce bacterial CLABSI in NICU patients.
Potential resistance, microbiome effects and adverse events limit the benefit–harm balance. Evidence confidence: very low; the studies predated modern bundles.
Conditions, related rules & sources for CLABSI: no routine prophylactic antimicrobial infusions
- This prevention recommendation is distinct from indicated treatment of a suspected or confirmed infection and from the conditional antimicrobial-lock option in a unit with ongoing CLABSI.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CLABSI: antimicrobial locks are a conditional additional measure
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Ongoing CLABSI in the unit, in addition to core prevention · Conditional recommendation
Consider central-line antimicrobial locks when a NICU has ongoing CLABSIs, in addition to core infection-prevention measures—not as a substitute for insertion and maintenance practices.
- Some infants need continuous infusions that cannot be interrupted and are exceptions to this approach. Locks interrupt fluid delivery; reported harms include hypoglycemia, product-related adverse effects and possible antimicrobial resistance.
- No antimicrobial agent, dose, lock duration or universal regimen is specified. Facilities may use their antibiogram and causative organisms when selecting an agent; catheter compatibility also matters.
- Evidence confidence: high, but indirectness limits applicability to current practice. All three trials had high baseline infection rates; benefit in units with much lower modern rates is less certain.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: no anticoagulant infusion for infection prevention
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Purpose: CLABSI prevention
Do not use prophylactic anticoagulant infusions for the purpose of preventing CLABSI in NICU patients.
There can be other clinical indications for heparin or anticoagulation; this is not a prohibition on every use. The agent is intentionally unspecified. Evidence confidence: moderate.
More conditions & sources (1) for CLABSI: no anticoagulant infusion for infection prevention
- The evidence did not show reduced catheter-related sepsis; effects on occlusion were inconsistent and harms may have been underreported.
Source dates & verification
- CDC · Recommendation 14
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
Conditions, related rules & sources for S. aureus: when to perform active surveillance
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
Conditions, related rules & sources for S. aureus surveillance: repeat at regular intervals
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Source dates & verification
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Conditional recommendation
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
Conditions, related rules & sources for S. aureus: consider surveillance on transfer admission
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Source dates & verification
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
Conditions, related rules & sources for S. aureus surveillance: culture or PCR
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Source dates & verification
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
Conditions, related rules & sources for S. aureus surveillance: sample at least the anterior nares
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Source dates & verification
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Conditional recommendation
S. aureus: targeted decolonization is a conditional addition
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Colonized infants · outbreak, ongoing transmission or increased infections
Consider targeted decolonization of S. aureus-colonized NICU patients during outbreak, ongoing healthcare-associated transmission or increased infection incidence, in addition to implementation of and adherence to appropriate infection-prevention measures.
The optimal population is left to the facility, and S. aureus includes MRSA/MSSA. There is no universal numerical trigger. Evidence confidence: low.
Conditions, related rules & sources for S. aureus: targeted decolonization is a conditional addition
- Potential harms include systemic agent absorption, resistance/tolerance/cross-resistance and skin reactions. Nasal ointment can be difficult to apply in very-low-birthweight infants, partly obstruct small nares and accumulate on nasal-cannula prongs.
- Targeted consideration does not establish an optimal agent or endorse universal decolonization. Those separate unresolved CDC positions and core precautions are available locally.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus: no established optimal decolonization agent
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
CDC 2020 neonatal evidence and safety cautions · Unresolved issue
The optimal decolonization agent or combination remains unresolved. CDC’s NICU guideline does not specify a preferred agent or a universal neonatal decolonization regimen.
- CDC’s 2020 report notes that intranasal mupirocin safety/efficacy was not established below age 12 years; systemic absorption occurs in neonates/premature infants, with uncertain clinical significance, and resistance can emerge. This is a dated source statement, not a separately verified current product label.
- The report cites chlorhexidine labeling to use with care in premature infants or those under 2 months. Reported concerns include chemical burns/skin reactions, systemic absorption of uncertain significance, tolerance and cross-resistance.
- Nasal ointment can partially occlude small nares and accumulate on oxygen-cannula prongs. Evidence confidence: low. No dose, course or clearance regimen is generated here; targeted decolonization criteria and continued precautions remain separate.
Related rule sources & dates
S. aureus: universal decolonization remains unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Not an endorsement of routine universal treatment · Unresolved issue
CDC makes no recommendation for universal decolonization of S. aureus-colonized NICU patients; its additional benefit and benefit–harm balance are unresolved.
- Systemic absorption, agent adverse effects and increased resistance with indiscriminate use are concerns. Evidence confidence: low. This unresolved position must not be presented as a routine decolonization protocol.
Related rule sources & dates
- CDC · Recommendation 2.b
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
NICU MRSA: Contact Precautions stop criteria unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
History of MRSA colonization or infection · Unresolved issue
CDC does not establish a procedure for discontinuing Contact Precautions in individual NICU patients with previous MRSA colonization or infection.
- Neonates can become recolonized after decolonization. Early discontinuation can increase transmission; continued precautions during hospitalization may prevent transmission from recurrent colonization.
- The review found no evidence supporting a specific stop protocol, including clearance after multiple negative cultures. Do not turn decolonization or a negative swab into an app-issued clearance rule.
- This question is MRSA-specific. The operational meaning of Contact Precautions is available locally; general isolation language does not resolve this NICU-specific discontinuation gap.
Related rule sources & dates
- CDC · Recommendation 3
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus: universal decolonization remains unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Not an endorsement of routine universal treatment
CDC makes no recommendation for universal decolonization of S. aureus-colonized NICU patients; its additional benefit and benefit–harm balance are unresolved.
Systemic absorption, agent adverse effects and increased resistance with indiscriminate use are concerns. Evidence confidence: low. This unresolved position must not be presented as a routine decolonization protocol.
Conditions, related rules & sources for S. aureus: universal decolonization remains unresolved
Source dates & verification
- CDC · Recommendation 2.b
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: targeted decolonization is a conditional addition
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Colonized infants · outbreak, ongoing transmission or increased infections · Conditional recommendation
Consider targeted decolonization of S. aureus-colonized NICU patients during outbreak, ongoing healthcare-associated transmission or increased infection incidence, in addition to implementation of and adherence to appropriate infection-prevention measures.
- The optimal population is left to the facility, and S. aureus includes MRSA/MSSA. There is no universal numerical trigger. Evidence confidence: low.
- Potential harms include systemic agent absorption, resistance/tolerance/cross-resistance and skin reactions. Nasal ointment can be difficult to apply in very-low-birthweight infants, partly obstruct small nares and accumulate on nasal-cannula prongs.
- Targeted consideration does not establish an optimal agent or endorse universal decolonization. Those separate unresolved CDC positions and core precautions are available locally.
Related rule sources & dates
S. aureus: no established optimal decolonization agent
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
CDC 2020 neonatal evidence and safety cautions · Unresolved issue
The optimal decolonization agent or combination remains unresolved. CDC’s NICU guideline does not specify a preferred agent or a universal neonatal decolonization regimen.
- CDC’s 2020 report notes that intranasal mupirocin safety/efficacy was not established below age 12 years; systemic absorption occurs in neonates/premature infants, with uncertain clinical significance, and resistance can emerge. This is a dated source statement, not a separately verified current product label.
- The report cites chlorhexidine labeling to use with care in premature infants or those under 2 months. Reported concerns include chemical burns/skin reactions, systemic absorption of uncertain significance, tolerance and cross-resistance.
- Nasal ointment can partially occlude small nares and accumulate on oxygen-cannula prongs. Evidence confidence: low. No dose, course or clearance regimen is generated here; targeted decolonization criteria and continued precautions remain separate.
Related rule sources & dates
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
NICU MRSA: Contact Precautions stop criteria unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
History of MRSA colonization or infection · Unresolved issue
CDC does not establish a procedure for discontinuing Contact Precautions in individual NICU patients with previous MRSA colonization or infection.
- Neonates can become recolonized after decolonization. Early discontinuation can increase transmission; continued precautions during hospitalization may prevent transmission from recurrent colonization.
- The review found no evidence supporting a specific stop protocol, including clearance after multiple negative cultures. Do not turn decolonization or a negative swab into an app-issued clearance rule.
- This question is MRSA-specific. The operational meaning of Contact Precautions is available locally; general isolation language does not resolve this NICU-specific discontinuation gap.
Related rule sources & dates
- CDC · Recommendation 3
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus: no established optimal decolonization agent
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
CDC 2020 neonatal evidence and safety cautions
The optimal decolonization agent or combination remains unresolved. CDC’s NICU guideline does not specify a preferred agent or a universal neonatal decolonization regimen.
CDC’s 2020 report notes that intranasal mupirocin safety/efficacy was not established below age 12 years; systemic absorption occurs in neonates/premature infants, with uncertain clinical significance, and resistance can emerge. This is a dated source statement, not a separately verified current product label.
Conditions, related rules & sources for S. aureus: no established optimal decolonization agent
- The report cites chlorhexidine labeling to use with care in premature infants or those under 2 months. Reported concerns include chemical burns/skin reactions, systemic absorption of uncertain significance, tolerance and cross-resistance.
- Nasal ointment can partially occlude small nares and accumulate on oxygen-cannula prongs. Evidence confidence: low. No dose, course or clearance regimen is generated here; targeted decolonization criteria and continued precautions remain separate.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: targeted decolonization is a conditional addition
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Colonized infants · outbreak, ongoing transmission or increased infections · Conditional recommendation
Consider targeted decolonization of S. aureus-colonized NICU patients during outbreak, ongoing healthcare-associated transmission or increased infection incidence, in addition to implementation of and adherence to appropriate infection-prevention measures.
- The optimal population is left to the facility, and S. aureus includes MRSA/MSSA. There is no universal numerical trigger. Evidence confidence: low.
- Potential harms include systemic agent absorption, resistance/tolerance/cross-resistance and skin reactions. Nasal ointment can be difficult to apply in very-low-birthweight infants, partly obstruct small nares and accumulate on nasal-cannula prongs.
- Targeted consideration does not establish an optimal agent or endorse universal decolonization. Those separate unresolved CDC positions and core precautions are available locally.
Related rule sources & dates
S. aureus: universal decolonization remains unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Not an endorsement of routine universal treatment · Unresolved issue
CDC makes no recommendation for universal decolonization of S. aureus-colonized NICU patients; its additional benefit and benefit–harm balance are unresolved.
- Systemic absorption, agent adverse effects and increased resistance with indiscriminate use are concerns. Evidence confidence: low. This unresolved position must not be presented as a routine decolonization protocol.
Related rule sources & dates
- CDC · Recommendation 2.b
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
NICU MRSA: Contact Precautions stop criteria unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
History of MRSA colonization or infection · Unresolved issue
CDC does not establish a procedure for discontinuing Contact Precautions in individual NICU patients with previous MRSA colonization or infection.
- Neonates can become recolonized after decolonization. Early discontinuation can increase transmission; continued precautions during hospitalization may prevent transmission from recurrent colonization.
- The review found no evidence supporting a specific stop protocol, including clearance after multiple negative cultures. Do not turn decolonization or a negative swab into an app-issued clearance rule.
- This question is MRSA-specific. The operational meaning of Contact Precautions is available locally; general isolation language does not resolve this NICU-specific discontinuation gap.
Related rule sources & dates
- CDC · Recommendation 3
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
NICU MRSA: Contact Precautions stop criteria unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
History of MRSA colonization or infection
CDC does not establish a procedure for discontinuing Contact Precautions in individual NICU patients with previous MRSA colonization or infection.
Neonates can become recolonized after decolonization. Early discontinuation can increase transmission; continued precautions during hospitalization may prevent transmission from recurrent colonization.
Conditions, related rules & sources for NICU MRSA: Contact Precautions stop criteria unresolved
- The review found no evidence supporting a specific stop protocol, including clearance after multiple negative cultures. Do not turn decolonization or a negative swab into an app-issued clearance rule.
- This question is MRSA-specific. The operational meaning of Contact Precautions is available locally; general isolation language does not resolve this NICU-specific discontinuation gap.
Source dates & verification
- CDC · Recommendation 3
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
S. aureus: targeted decolonization is a conditional addition
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Colonized infants · outbreak, ongoing transmission or increased infections · Conditional recommendation
Consider targeted decolonization of S. aureus-colonized NICU patients during outbreak, ongoing healthcare-associated transmission or increased infection incidence, in addition to implementation of and adherence to appropriate infection-prevention measures.
- The optimal population is left to the facility, and S. aureus includes MRSA/MSSA. There is no universal numerical trigger. Evidence confidence: low.
- Potential harms include systemic agent absorption, resistance/tolerance/cross-resistance and skin reactions. Nasal ointment can be difficult to apply in very-low-birthweight infants, partly obstruct small nares and accumulate on nasal-cannula prongs.
- Targeted consideration does not establish an optimal agent or endorse universal decolonization. Those separate unresolved CDC positions and core precautions are available locally.
Related rule sources & dates
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus: no established optimal decolonization agent
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
CDC 2020 neonatal evidence and safety cautions · Unresolved issue
The optimal decolonization agent or combination remains unresolved. CDC’s NICU guideline does not specify a preferred agent or a universal neonatal decolonization regimen.
- CDC’s 2020 report notes that intranasal mupirocin safety/efficacy was not established below age 12 years; systemic absorption occurs in neonates/premature infants, with uncertain clinical significance, and resistance can emerge. This is a dated source statement, not a separately verified current product label.
- The report cites chlorhexidine labeling to use with care in premature infants or those under 2 months. Reported concerns include chemical burns/skin reactions, systemic absorption of uncertain significance, tolerance and cross-resistance.
- Nasal ointment can partially occlude small nares and accumulate on oxygen-cannula prongs. Evidence confidence: low. No dose, course or clearance regimen is generated here; targeted decolonization criteria and continued precautions remain separate.
Related rule sources & dates
S. aureus: universal decolonization remains unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Not an endorsement of routine universal treatment · Unresolved issue
CDC makes no recommendation for universal decolonization of S. aureus-colonized NICU patients; its additional benefit and benefit–harm balance are unresolved.
- Systemic absorption, agent adverse effects and increased resistance with indiscriminate use are concerns. Evidence confidence: low. This unresolved position must not be presented as a routine decolonization protocol.
Related rule sources & dates
- CDC · Recommendation 2.b
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus: use local epidemiology; no universal trigger or risk score
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
NICU infection-prevention program
Use the unit’s infection/colonization data and epidemiology to decide when additional S. aureus interventions are needed. CDC gives no discrete universal infection-rate threshold for escalation.
The evidence review did not establish actionable recommendations from modifiable individual risk factors. Do not derive a neonatal treatment or screening score from the appendix’s observational associations.
Conditions, related rules & sources for S. aureus: use local epidemiology; no universal trigger or risk score
- Core practices remain foundational. The guideline covers selected NICU prevention questions and is not a comprehensive treatment guideline for S. aureus infection or a substitute for all infection-control policies.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
S. aureus: when to perform active surveillance
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Unit outbreak, increased incidence or ongoing MRSA transmission · Screening
Perform S. aureus colonization surveillance during an outbreak or increased S. aureus infection incidence. Perform MRSA surveillance with evidence of ongoing healthcare-associated MRSA transmission. S. aureus includes MRSA and MSSA; the MRSA-specific ongoing-transmission rule is not automatically an MSSA rule.
- Increased-incidence/outbreak surveillance and routine ongoing-transmission surveillance are different questions.
- CDC leaves routine MSSA surveillance solely to detect ongoing MSSA transmission unresolved. Distinguish that from surveillance for both organisms during increased infection incidence or outbreak.
- A cluster or rise above a unit’s historical incidence or published comparison data can constitute increased incidence. Ongoing MRSA transmission can be suggested by rising colonization or infection detected on surveillance or clinically indicated cultures.
- There is no universal numerical infection-rate trigger; use unit epidemiology. Evidence confidence: low for 1.a/1.b; no supporting evidence for 1.c. Nasal swabs may cause discomfort/traumatic bleeding.
Related rule sources & dates
S. aureus: targeted decolonization is a conditional addition
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Colonized infants · outbreak, ongoing transmission or increased infections · Conditional recommendation
Consider targeted decolonization of S. aureus-colonized NICU patients during outbreak, ongoing healthcare-associated transmission or increased infection incidence, in addition to implementation of and adherence to appropriate infection-prevention measures.
- The optimal population is left to the facility, and S. aureus includes MRSA/MSSA. There is no universal numerical trigger. Evidence confidence: low.
- Potential harms include systemic agent absorption, resistance/tolerance/cross-resistance and skin reactions. Nasal ointment can be difficult to apply in very-low-birthweight infants, partly obstruct small nares and accumulate on nasal-cannula prongs.
- Targeted consideration does not establish an optimal agent or endorse universal decolonization. Those separate unresolved CDC positions and core precautions are available locally.
Related rule sources & dates
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: repeat at regular intervals
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Only if a surveillance program is implemented · Recommendation
When NICU S. aureus surveillance is implemented, test at regular intervals to identify newly colonized infants promptly.
- The facility may select weekly, more frequent or less frequent testing based on baseline colonization/infection and changing epidemiology. CDC does not mandate universal weekly testing.
- Whether to add admission testing is a facility/health-system decision. Surveillance detects colonization; it is not by itself a clinical infection diagnosis. Evidence confidence: low.
Related rule sources & dates
- CDC · Recommendation 1.d
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: consider surveillance on transfer admission
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Outborn infants or transfer from another newborn unit · Conditional recommendation
If S. aureus surveillance is implemented, consider testing outborn or transferred newborn-unit infants on admission to identify colonization promptly.
- This is conditional, not a mandate to test every newborn on admission. Facilities can consider their own epidemiology when selecting the admission population; outborn/transferred infants had higher prevalence in the supporting evidence.
- The term includes MRSA and MSSA. Evidence confidence: low, with limited generalizability; swabbing can cause discomfort or mucosal bleeding.
Related rule sources & dates
- CDC · Recommendation 1.e
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: culture or PCR
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Either culture or PCR is acceptable for NICU S. aureus colonization surveillance. Select using performance, laboratory capacity, turnaround, susceptibility testing and outbreak-investigation needs.
- PCR is marginally more sensitive and may be faster, but has lower MRSA specificity and does not provide an isolate for strain typing. Culture provides organisms for susceptibility/typing but can miss a small number of colonized infants.
- This applies to MRSA and MSSA surveillance, not selection of a diagnostic or treatment regimen for an individual infection. Evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.f
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus surveillance: sample at least the anterior nares
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
If active surveillance is performed · Recommendation
Collect surveillance samples from at least the anterior nares. Additional axillary, rectal or umbilical sampling can increase detection, particularly when greater sensitivity is needed in an outbreak.
- Nares alone can miss infants colonized only elsewhere. Additional sampling’s effect on clinical outcomes and its cost–benefit are uncertain; this is not a requirement to sample every site in every infant.
- Samples may be combined for a composite assay where appropriate. Swabbing can cause discomfort or nasal trauma/bleeding. The source includes MRSA and MSSA; evidence confidence: moderate.
Related rule sources & dates
- CDC · Recommendation 1.g
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
S. aureus: no established optimal decolonization agent
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
CDC 2020 neonatal evidence and safety cautions · Unresolved issue
The optimal decolonization agent or combination remains unresolved. CDC’s NICU guideline does not specify a preferred agent or a universal neonatal decolonization regimen.
- CDC’s 2020 report notes that intranasal mupirocin safety/efficacy was not established below age 12 years; systemic absorption occurs in neonates/premature infants, with uncertain clinical significance, and resistance can emerge. This is a dated source statement, not a separately verified current product label.
- The report cites chlorhexidine labeling to use with care in premature infants or those under 2 months. Reported concerns include chemical burns/skin reactions, systemic absorption of uncertain significance, tolerance and cross-resistance.
- Nasal ointment can partially occlude small nares and accumulate on oxygen-cannula prongs. Evidence confidence: low. No dose, course or clearance regimen is generated here; targeted decolonization criteria and continued precautions remain separate.
Related rule sources & dates
S. aureus: universal decolonization remains unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
Not an endorsement of routine universal treatment · Unresolved issue
CDC makes no recommendation for universal decolonization of S. aureus-colonized NICU patients; its additional benefit and benefit–harm balance are unresolved.
- Systemic absorption, agent adverse effects and increased resistance with indiscriminate use are concerns. Evidence confidence: low. This unresolved position must not be presented as a routine decolonization protocol.
Related rule sources & dates
- CDC · Recommendation 2.b
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
NICU MRSA: Contact Precautions stop criteria unresolved
CDC · United States · NICU patients; MRSA and MSSA conditions remain distinct.
History of MRSA colonization or infection · Unresolved issue
CDC does not establish a procedure for discontinuing Contact Precautions in individual NICU patients with previous MRSA colonization or infection.
- Neonates can become recolonized after decolonization. Early discontinuation can increase transmission; continued precautions during hospitalization may prevent transmission from recurrent colonization.
- The review found no evidence supporting a specific stop protocol, including clearance after multiple negative cultures. Do not turn decolonization or a negative swab into an app-issued clearance rule.
- This question is MRSA-specific. The operational meaning of Contact Precautions is available locally; general isolation language does not resolve this NICU-specific discontinuation gap.
Related rule sources & dates
- CDC · Recommendation 3
Prevention and control of S. aureus infections in NICU patients · Updated August 2020; recommendation web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
More conditions & sources (1) for Core precautions: hand hygiene around every care task
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Source dates & verification
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
Conditions, related rules & sources for Core precautions: training, resources, monitoring and early device removal
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Source dates & verification
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
More conditions & sources (1) for Core precautions: surfaces and reusable equipment
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Source dates & verification
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
Conditions, related rules & sources for Core precautions: aseptic medication preparation and injection safety
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
Conditions, related rules & sources for Core precautions: indicated PPE and additional transmission precautions
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
Conditions, related rules & sources for Core precautions: respiratory exposure and staff illness
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Source dates & verification
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
Conditions, related rules & sources for Catheter baseline: competent aseptic insertion and access
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
Conditions, related rules & sources for Contact Precautions: locally readable operational baseline
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CDC catheter timing: older general guidance differs from NICU 2022
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
2011 general catheter statement versus 2022 NICU-specific options
The older CDC general catheter guidance says UACs optimally should not remain >5 days and UVCs may be used up to 14 days if managed aseptically, with prompt removal when unneeded. The 2022 NICU guideline instead conditionally suggests considering removal of either by 7 dwell days.
Within CDC: 2011 general UAC≤5/UVC≤14 statements and 2022 NICU conditional ≤7-day options differ. They retain their own scope/category and are not silently reconciled.
These are different source documents and categories, not one merged cutoff. The app does not resolve clinical precedence from the publication date; use the exact source and applicable approved policy.
Conditions, related rules & sources for CDC catheter timing: older general guidance differs from NICU 2022
- The 2011 general guideline also says not to routinely replace CVCs/PICCs solely for infection prevention. The 2022 NICU chapter specifically leaves replacement of a prolonged PICC with ongoing access need unresolved.
- For umbilical malfunction, the older statement allows replacement only with no other removal indication and within its total 5-day UAC/14-day UVC duration; this does not erase infection/thrombosis/vascular-insufficiency removal indications in that older source. No patient replacement decision is calculated here.
- The older umbilical time statements are Category II; the 2022 NICU ≤7-day options are Conditional Recommendations. Publication dates alone do not settle this source difference.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
UAC and UVC: removal and longer-term access
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Remove promptly when no longer needed; conditional ≤7-day options · Recommendation
Remove umbilical arterial and venous catheters as soon as possible when no longer needed. CDC’s 2022 NICU guideline conditionally suggests considering UAC or UVC removal at or before 7 days of dwell time.
- Remove UAC/UVC promptly when no longer needed regardless of these conditional time points. These are dwell days, not postnatal-age thresholds.
- For infants needing long-term central venous access, consider removing the UVC and placing a PICC or other long-term central venous catheter at or before 7 days of UVC dwell time. This is a conditional option, not an automatic patient-specific replacement order.
- No optimal exact removal day was established; balance dwell time and infection risk with clinical access needs. Evidence confidence by CDC recommendation: 9.a (prompt UAC/UVC removal), very low; 9.b (UAC at or before 7 dwell days), low; 9.c (UVC at or before 7 dwell days), very low; 9.d (UVC-to-long-term access at or before 7 dwell days), low. Recommendations 9.b–9.d are conditional.
- Dwell time means time the catheter has been in place, not the infant’s age. The older CDC general-catheter source has different umbilical time statements; both document-specific positions are shown locally.
Related rule sources & dates
- CDC · Recommendations 9.a–9.d
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27 - CDC · Sections16.7–16.9: differing older general time statements
Prevention of intravascular catheter-related infections: selected baseline sections · 2011 general catheter guideline; web summary February 28, 2024; selected prerequisite/comparison material, not full extraction
Source checked 2026-10-27
PICC: remove when unneeded; routine prolonged-line replacement unresolved
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Ongoing clinical need versus unnecessary dwell time · Recommendation
Remove a PICC as soon as possible when no longer needed. If central access is still required, CDC’s 2022 NICU guideline does not resolve whether a long-standing PICC should be removed and replaced solely to prevent CLABSI.
- No specific PICC day was established at which infection risk changes enough to prescribe routine replacement. Evidence confidence: very low. Do not apply the umbilical catheter’s 7-day conditional option to a PICC.
- The older general CDC catheter guidance says not to routinely replace CVCs/PICCs solely to prevent infection. Its separate source/version is provided locally; the NICU statement’s unresolved status remains explicit.
Related rule sources & dates
CLABSI: select catheter and insertion site by clinical need
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Before choosing central vascular access · Recommendation
Choose catheter type and its appropriate insertion site based on clinical needs; do not choose either solely for CLABSI prevention.
- Consider chronologic/gestational age, size, congenital abnormalities, prior devices, expected duration and available access/expertise. The guideline does not establish one universally safest catheter type or site.
- Available sites can be limited; repeated attempts and mechanical complications matter. Femoral access can present maintenance challenges in diapered infants.
- Evidence confidence: very low for catheter type; low for site selection. Findings on infection and other complications are inconsistent and confounded by patient need.
Related rule sources & dates
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
CLABSI: use the fewest lumens needed
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Match lumen count to clinical requirements · Conditional recommendation
Consider the fewest catheter lumens that meet the NICU patient’s clinical needs.
- This is conditional, not a requirement to use one lumen regardless of care needs. Evidence confidence is low; the comparison can be confounded because infants needing more complex care may need more access.
Related rule sources & dates
- CDC · Recommendation 4
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update · Recommendation
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
- This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Catheter dressings: neonatal CHG cautions and care
CDC 2017 dressing update and selected 2011 site care · Premature versus non-premature neonates remain distinct.
Site care and dressing changes; 2017 neonatal CHG dressing update
Chlorhexidine-impregnated dressings are not recommended for premature neonates with short-term non-tunneled CVCs because of serious skin-reaction risk. For non-premature neonates/children under 18 years, CDC makes no recommendation because efficacy/safety evidence is insufficient.
This is different from conditional liquid CHG skin antisepsis or CHG bathing in the 2022 NICU chapter; do not substitute one intervention’s recommendation for another.
Conditions, related rules & sources for Catheter dressings: neonatal CHG cautions and care
- Use sterile gauze or sterile transparent semipermeable dressings; gauze is preferred while bleeding/oozing or diaphoresis persists. Replace a dressing when damp, loose or visibly soiled and ensure compatibility with the catheter.
- The selected general source gives short-term CVC gauze changes every 2 days and transparent changes at least every 7 days. The transparent-dressing recommendation has an exception where pediatric catheter-dislodgement risk outweighs the benefit of changing. For tunneled/implanted sites, transparent changes are no more than weekly until healed unless loose/soiled. These are dressing intervals, not catheter-replacement or infant-age rules.
- Assess the site regularly by visual inspection during changes or palpation through an intact dressing according to clinical situation. Remove the dressing to examine the site if tenderness, unexplained fever or other local/bloodstream infection signs occur. A need for dressing at a well-healed long-term cuffed/tunneled exit site is unresolved.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
Catheter baseline: competent aseptic insertion and access
CDC 2011 general catheter guidance · Selected baseline/comparison material; distinct from 2022 NICU-specific recommendations.
Selected general CDC prerequisites supporting NICU bundles · Recommendation
Use trained competent personnel, hand hygiene and aseptic catheter insertion/care. For CVC/PICC insertion or guidewire exchange, use cap, mask, sterile gown/gloves and a sterile full-body drape.
- Perform hand hygiene before/after palpation and insertion/replacement/access/repair/dressing care; do not palpate after antisepsis unless asepsis is maintained. Use sterile gloves for arterial, central and midline insertion and new sterile gloves for guidewire handling.
- Allow antiseptics to dry by manufacturer directions. Cover sites with sterile gauze or sterile transparent semipermeable dressings; change a dressing that is damp, loose or visibly soiled.
- Before access, disinfect catheter access ports with an appropriate antiseptic and access only with sterile devices. Follow neonatal product safety/compatibility and local approved procedures; do not import an adult antiseptic concentration as universal neonatal eligibility.
- Skin antisepsis and CHG-dressing use have separate neonatal age/maturity restrictions in the related local rules. This is selected baseline practice, not a complete extraction of the 2011 general catheter guideline.
- The 2011 general source says to replace a catheter as soon as possible, within 48 h, if aseptic insertion could not be assured (for example during an emergency). It also advises against topical antibiotic ointments/creams at insertion sites except dialysis indications, and against submerging a catheter/site. Dressing-specific neonatal cautions are in the related local record.
Related rule sources & dates
CLABSI: alcohol-containing chlorhexidine skin antisepsis
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Catheter insertion and maintenance · individual risk–benefit assessment · Conditional recommendation
Consider alcohol-containing chlorhexidine for skin antisepsis only when benefits are judged to outweigh potential risks. Assess gestational age, chronologic age and skin maturity; it is not appropriate for every NICU patient.
Within CDC: the 2011 general source leaves CHG safety/efficacy under 2 months unresolved; the 2022 NICU chapter offers conditional antisepsis after GA/age/skin risk–benefit assessment. Neither establishes universal neonatal eligibility.
- CDC does not specify a universally eligible NICU population, neonatal age/weight cutoff, or a preferred neonatal concentration in this recommendation. Do not turn trial enrollment criteria into an eligibility rule.
- Systemic chlorhexidine absorption was reported; long-term clinical and microbiome effects are uncertain. The supporting trial enrolled infants >1500 g and >7 days; harms were not assessed in smaller or younger infants. Evidence confidence: very low.
- Allow antiseptic to dry according to manufacturer instructions before catheter placement. This skin-preparation option is separate from chlorhexidine bathing and chlorhexidine-impregnated dressings.
Related rule sources & dates
CLABSI: chlorhexidine bathing and its limits
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Benefits must outweigh risks; eligibility and frequency unresolved · Conditional recommendation
Consider chlorhexidine bathing when benefits outweigh risks. CDC makes no recommendation identifying which NICU patients benefit or how often bathing should occur.
Within CDC: the 2011 general source describes daily 2% CHG cleansing; 2022 NICU recommendations leave population and frequency unresolved and bathing conditional. The general schedule is not silently applied to neonates.
- The delivery method, frequency and target population are intentionally unspecified; this is not a universal daily-bath schedule. Chlorhexidine bathing is inappropriate for some infants.
- Evidence confidence: low. Benefits were suggested mainly in units with high baseline CLABSI rates despite insertion/maintenance bundles and other infection-prevention practices; one single bath did not show benefit. This evidence context is not a newly defined numerical unit threshold.
- Long-term effects on resistance, cross-resistance, systemic absorption and the microbiome were inadequately assessed. Do not infer safety in every preterm infant from an absence of reported skin reactions in selected studies.
Related rule sources & dates
Core precautions: hand hygiene around every care task
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All patient care; before aseptic/device tasks and after gloves · Recommendation
Perform hand hygiene before touching a patient, before aseptic/device handling, before moving from a soiled to clean site, after touching the patient/environment or body fluids, and immediately after glove removal.
- Use soap and water for visibly soiled hands. Otherwise alcohol-based hand rub is preferred in most clinical situations. Keep supplies readily accessible.
- Gloves do not replace hand hygiene. These baseline requirements remain applicable even where the CLABSI guideline leaves routine extra gloves for every contact unresolved.
Related rule sources & dates
CLABSI: use insertion and maintenance bundles
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Insertion, continued use and quality improvement · Recommendation
Use bundled central-line insertion and maintenance interventions within a quality-improvement effort to reduce NICU CLABSI. Follow the established CDC baseline measures; no optimal additional NICU-specific bundle was established.
- Bundles studied in NICUs differed, and no study directly compared one complete bundle against another. Do not infer that a particular local bundle, product or number of components is universally best. Evidence confidence: low.
- Core and selected catheter-specific baseline practices are locally available: competent personnel, hand hygiene, aseptic insertion/access, maximal sterile barriers for central insertion, appropriate skin/dressing care, and removal of unnecessary devices.
Related rule sources & dates
Core precautions: aseptic medication preparation and injection safety
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Each preparation, vial entry and administration · Recommendation
Prepare medication aseptically in a clean area separated from contamination/water sources. Disinfect vial diaphragms before entry, and use a new sterile needle and syringe for each entry—even an additional dose for the same patient.
- Needles/syringes, infusion sets and single-dose vials/ampules/solution containers are for one patient only. Changing a needle does not make a used syringe safe for another patient.
- Dedicate multidose vials to one patient where possible; if used for multiple patients, keep them in a centralized medication area away from the bedside.
- Wear a facemask for epidural/subdural catheter placement or injections. For central vascular/PICC insertion or guidewire exchange, the selected catheter baseline requires cap, mask, sterile gown/gloves and a sterile full-body drape.
Related rule sources & dates
Core precautions: indicated PPE and additional transmission precautions
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Standard Precautions for everyone; additional precautions when indicated · Recommendation
Choose PPE by anticipated exposure: gloves for contact with infectious material, mucosa, nonintact/potentially contaminated skin or equipment; gown for likely skin/clothing contamination; eye/face protection for splashes or sprays.
- Do not reuse gloves/gowns between patients or wash gloves for reuse. Remove/discard task PPE before leaving the care area; respirators are removed after leaving/closing the room as appropriate. Staff need accessible PPE and training in selection/donning/removal.
- Add transmission-based precautions for suspected/documented substantial transmission risk beyond Standard Precautions; adapt to the setting, room design and interaction, and implement promptly based on presentation.
- Use a single-patient room while awaiting assessment when possible and notify receiving facilities/transport services of indicated precautions. Specific Contact Precautions operations and the NICU MRSA stop-criteria gap are distinct.
Related rule sources & dates
Core precautions: surfaces and reusable equipment
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Between patients, when soiled, and scheduled environmental cleaning · Recommendation
Clean/disinfect frequently touched and near-patient surfaces more often than low-contact surfaces. Promptly decontaminate blood/body-fluid spills; clean/reprocess reusable equipment before another patient or when soiled.
- Select EPA-registered products effective against likely pathogens and follow manufacturer dilution, contact time, compatibility, storage and disposal instructions. Do not invent one contact time for every product.
- Follow equipment-specific disinfection/sterilization instructions, separate clean and soiled equipment, train reprocessing staff and document competency initially, with new equipment and periodically.
Related rule sources & dates
- CDC · Core Practices Table 5b/5f
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
Core precautions: training, resources, monitoring and early device removal
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
All healthcare personnel and facility leadership · Recommendation
Provide trained infection-prevention leadership, adequate staffing/resources, written current policies, demonstrated staff competence and task-specific training before duties and at least annually. Monitor adherence/infections and give timely feedback.
- Retrain after lapses, new threats, procedures or equipment. Use standardized monitoring tools/definitions, detect transmission and act on unit data; this website does not collect or track patient/unit data.
- Educate families/caregivers/visitors about transmission, prevention and concerning symptoms, using appropriate language and communication methods.
- At every healthcare encounter, reassess the necessity of invasive devices and identify the earliest safe removal opportunity. Use recommended insertion/maintenance practice; unit-specific additional measures complement this baseline.
Related rule sources & dates
- CDC · Core Practices Table 1–4 and 7
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CLABSI: minimize hub access and central-line sampling
CDC · United States · NICU patients with central vascular access; 2022 NICU-specific prevention guidance.
Every central-line access · Recommendation
Minimize hub accesses and blood sampling through central lines to reduce CLABSI risk. Coordinate multiple access needs while preserving required disinfection and aseptic technique.
- Hub manipulation includes a range of actions, including disinfection and access; CDC did not evaluate a specific access-reduction strategy. Do not interpret “minimize” as permission to skip disinfection. Evidence confidence: very low.
Related rule sources & dates
- CDC · Recommendation 7
NICU central line-associated bloodstream infection prevention · February 2022 guideline; recommendation web page March 19, 2024
Source checked 2026-10-27
Contact Precautions: locally readable operational baseline
CDC general Contact Precautions · Operational baseline when indicated; NICU MRSA discontinuation remains unresolved.
When Contact Precautions are indicated; not an MRSA clearance protocol · Recommendation
For Contact Precautions, don gloves on room/cubicle entry for patient or nearby-surface contact. Wear a gown on entry when clothing contact with the patient or nearby contaminated surfaces/equipment is anticipated; remove gown and perform hand hygiene before leaving the patient environment.
- Use a single room when available. If cohorting is necessary, use suitable patients with the same pathogen; if mixing with a noncolonized patient is unavoidable, avoid highly vulnerable roommates, separate by >3 feet with a curtain, and change protective attire/clean hands between patients.
- Limit transport to medically necessary purposes; contain/cover colonized or infected body areas, remove contaminated PPE and clean hands before transport, and use clean PPE at the destination. Use dedicated/disposable noncritical equipment or clean/disinfect before another patient. Prioritize frequent (for example at least daily) cleaning of near-patient/high-touch surfaces.
- This is operational baseline from general CDC isolation guidance, not an order to institute or stop precautions for an individual. Do not use general discontinuation language to fill the separate unresolved NICU MRSA stop criteria.
Related rule sources & dates
Core precautions: respiratory exposure and staff illness
CDC core practices · All healthcare settings; baseline precautions supporting NICU prevention.
Facility entry, respiratory-virus surges and occupational health · Recommendation
Use early detection, respiratory hygiene, source control and appropriate separation/precautions for potentially infectious people. Support staff staying home with acute infectious symptoms and reporting potentially transmissible illness through occupational health.
- Provide symptomatic patients/visitors tissues, masks, hand-hygiene supplies and instructions. During high community respiratory-virus transmission, consider broader entry masking based on facility risk assessment, potentially targeted to high-risk areas/outbreaks.
- Staff should have recommended vaccination or documented immunity, and facilities should follow applicable occupational protections. This is general workforce policy, not an infant immunization schedule or an app-issued fitness-for-work decision.
Related rule sources & dates
- CDC · Core Practices Table 5e/8
Core infection prevention and control practices for safe healthcare delivery in all settings · Core practices reviewed/updated October 2022; web page April 12, 2024
Source checked 2026-10-27
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
Conditions, related rules & sources for CCHD: current pass, retest and fail thresholds
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
Conditions, related rules & sources for CCHD: when and where to screen
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
Conditions, related rules & sources for CCHD: assessment after a failed screen
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
More conditions & sources (1) for CCHD: a passing screen does not exclude heart disease
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Source dates & verification
CCHD screening: cardiac and noncardiac conditions detected
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Screening targets are not a differential diagnosis generated by the app
Pulse-ox screening can detect several hypoxemic critical heart defects and can also identify non-CCHD causes of low oxygen saturation. It does not detect every case of any listed condition.
CDC lists coarctation of the aorta, hypoplastic left heart syndrome, double-outlet right ventricle, Ebstein anomaly, single ventricle, interrupted aortic arch, tetralogy of Fallot, pulmonary atresia, total anomalous pulmonary venous return, d-transposition of the great arteries, tricuspid atresia, truncus arteriosus and other critical defects.
Conditions, related rules & sources for CCHD screening: cardiac and noncardiac conditions detected
- Its non-CCHD list includes hemoglobinopathy, hypothermia, infection including sepsis, congenital/acquired lung disease, noncritical CHD, persistent pulmonary hypertension and other hypoxic conditions.
- A passing screen can still miss CCHD. These published lists are reference data, not a patient-specific diagnosis or an assertion that every listed lesion reliably causes hypoxemia.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
Conditions, related rules & sources for AAP 2025: both-site pass requirement and one retest
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
Conditions, related rules & sources for CCHD: older FAQ wording differs from the current algorithm
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
CCHD in the NICU: oxygen, prior echo and discharge checks
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · NICU and special settings
For NICU infants without a prior echocardiogram, the FAQ describes following the CCHD screening protocol once supplemental oxygen has been weaned. Routine pulse-ox monitoring is not necessarily pre- AND postductal screening.
Prematurity, lung disease and other illness complicate saturation interpretation; screening at 24 hours is often not possible in this setting. This is not a protocol for withdrawing necessary oxygen.
Conditions, related rules & sources for CCHD in the NICU: oxygen, prior echo and discharge checks
- The FAQ says prior echocardiography may remove the need for a separate screen, but some state rules require screening despite a prior echo. Check applicable state/local policy rather than treating the educational exception as universal.
- For systemic disease/congenital anomalies or transfers, avoid missed screening and confirm completion before discharge home unless already performed or an applicable prior-echo exception applies. Its numeric FAQ algorithm wording is older; the current CDC thresholds and exact source difference remain local.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD screening: eligibility, state rules and family communication
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · local implementation requirements · Implementation context
Plan to screen eligible newborns and check state-specific requirements. The FAQ describes known CCHD or a prior echocardiogram as possible exceptions, while noting some states require screening despite prior testing or diagnosis.
- Rare reasons for not screening can include serious conditions for which no intervention would be offered; these are described educational exceptions, not app eligibility decisions. Follow applicable state and hospital requirements.
- Inform parents beforehand. If parents decline, explain screening benefits and document persistent refusal in the clinical record. Consent/signature procedures follow local hospital policy; this directory does not determine legal requirements.
- Check the state’s recommended algorithm; the FAQ points to the AAP-endorsed/CDC diagram where a state algorithm is absent. Its own older numeric FAQ answers must not be substituted for the explicitly updated algorithm.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
Conditions, related rules & sources for CCHD screening: trained staff and neonatal pulse oximeters
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
Conditions, related rules & sources for CCHD failed-screen response: stability, consultation and discharge
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD screening: eligibility, state rules and family communication
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · local implementation requirements
Plan to screen eligible newborns and check state-specific requirements. The FAQ describes known CCHD or a prior echocardiogram as possible exceptions, while noting some states require screening despite prior testing or diagnosis.
Rare reasons for not screening can include serious conditions for which no intervention would be offered; these are described educational exceptions, not app eligibility decisions. Follow applicable state and hospital requirements.
Conditions, related rules & sources for CCHD screening: eligibility, state rules and family communication
- Inform parents beforehand. If parents decline, explain screening benefits and document persistent refusal in the clinical record. Consent/signature procedures follow local hospital policy; this directory does not determine legal requirements.
- Check the state’s recommended algorithm; the FAQ points to the AAP-endorsed/CDC diagram where a state algorithm is absent. Its own older numeric FAQ answers must not be substituted for the explicitly updated algorithm.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: high altitude, home birth and missed outpatient screening
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · special settings
The FAQ describes the same screening protocol for planned home births, ideally at ≥24 hours, with timely repeat testing and prompt evaluation after failure. For an unscreened infant, screening may be considered at the first newborn outpatient visit with a follow-up plan.
At high altitude, lower saturations may increase false positives; the FAQ gives >800 meters as an example and says further research is needed before modifying the algorithm. This does not establish a validated alternate saturation cutoff.
Conditions, related rules & sources for CCHD: high altitude, home birth and missed outpatient screening
- The asymptomatic window varies and infants with unrecognized CCHD may become symptomatic within the first two weeks. Screening belongs primarily before birth-hospital discharge; the outpatient option is not permission to delay a failed-screen evaluation.
- An office choosing to screen needs plans for repeat measurements and failed screens. Use the current separately attributed CDC algorithm; the FAQ’s numeric/repeat wording is older and differs.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: current pass, retest and fail thresholds
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Right hand AND one foot · one retest after 1 hour · Thresholds
In CDC’s current algorithm, SpO₂ <90% in either the right hand or foot fails immediately. Passing requires ≥95% at BOTH sites and an absolute hand–foot difference ≤3 percentage points. An initial result that meets neither rule is repeated once after 1 hour.
- Applies after the off-supplemental-oxygen and ≥24-hour-or-pending-discharge gates. Percentages are pulse-ox oxygen saturation, not a computed patient value.
- The immediate <90% rule takes priority. Exactly 90% is not <90%; an initial nonpassing result without <90% follows the one-hour retest branch.
- The ≤3 boundary is the absolute hand–foot difference in percentage points. Both saturation and difference conditions must be met to pass. Two nonpassing measures are separated by one hour.
- At retest, both pass conditions must be met; otherwise the screen fails. Do not add a second retest. A failed screen requires immediate clinical assessment; do not wait for another screening attempt.
- CDC’s text also describes failure as <95% at either site or a >3-percentage-point difference on two measurements separated by one hour. This table paraphrases its actual flowchart, including both entry gates and both final branches.
- These are general published screening rules, not an oxygen target, congenital-heart diagnosis or patient-specific result. The linked AAP educational FAQ contains older/contradictory wording; its differences are shown separately.
Related rule sources & dates
CCHD: when and where to screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
At least 24 hours old, or as late as possible before earlier discharge · Screening
Screen healthy-appearing newborns at ≥24 hours of age. If discharge will occur before 24 hours, screen as late as possible before discharge. In NICU or other settings, screening follows weaning off supplemental oxygen.
- Screen while the newborn is alert and off supplemental oxygen to reduce false positives. This is screening guidance, not a protocol for withdrawing needed oxygen or evaluating a symptomatic infant.
- CDC suggests coordinating with newborn hearing screening for efficiency. Pulse oximetry supplements, rather than replaces, family/pregnancy history and the physical examination. The current sites, thresholds and response are available locally.
Related rule sources & dates
CCHD screening: eligibility, state rules and family communication
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · local implementation requirements · Implementation context
Plan to screen eligible newborns and check state-specific requirements. The FAQ describes known CCHD or a prior echocardiogram as possible exceptions, while noting some states require screening despite prior testing or diagnosis.
- Rare reasons for not screening can include serious conditions for which no intervention would be offered; these are described educational exceptions, not app eligibility decisions. Follow applicable state and hospital requirements.
- Inform parents beforehand. If parents decline, explain screening benefits and document persistent refusal in the clinical record. Consent/signature procedures follow local hospital policy; this directory does not determine legal requirements.
- Check the state’s recommended algorithm; the FAQ points to the AAP-endorsed/CDC diagram where a state algorithm is absent. Its own older numeric FAQ answers must not be substituted for the explicitly updated algorithm.
Related rule sources & dates
CCHD: assessment after a failed screen
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
Immediate assessment and pediatrician notification · Escalation
Evaluate a failed screen for causes of hypoxemia and notify the infant’s pediatrician immediately. Most evaluations include echocardiography; cardiology assessment may be needed.
- CDC says an echocardiogram may not be necessary if a reversible cause of hypoxemia is identified and appropriately treated. A positive screen is not a diagnosis of CCHD; infection, lung disease and other causes must also be considered.
- The screening algorithm calls for immediate clinical assessment rather than another pulse-ox screening attempt after failure. The separately attributed educational FAQ describes stability assessment, consultation/transfer and evaluation before discharge.
Related rule sources & dates
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
CCHD screening: trained staff and neonatal pulse oximeters
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · technique and equipment · Implementation context
Screeners should have pulse-oximetry testing within their scope of practice, be trained in pulse oximetry and the CCHD algorithm, and regularly use pulse oximetry for other purposes. The provider of record is responsible for assuring appropriate screening completion.
- Use hospital-grade pulse oximeters designed for neonates, with neonatal probes recommended by the manufacturer for that device. A waveform helps judge signal tracking; perfusion index is not part of this algorithm and an embedded screening algorithm is not required.
- The FAQ describes right-hand and either-foot measurements in room air; when using one oximeter, obtain the measurements one after the other. This is educational technique context, not authority to use its older numeric/retest wording.
- Reusable probes and coordinating screening with other care may reduce costs/staff time. This is implementation context; no reimbursement or billing rule is issued here.
Related rule sources & dates
CCHD: older FAQ wording differs from the current algorithm
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
2023 educational FAQ versus explicit 2025 algorithm changes · Source difference
The AAP-hosted FAQ still describes ≥95% in the hand OR foot and as many as two retests in its implementation answer. The 2025 report explicitly changes those features to BOTH measurements and ONE retest; CDC’s current diagram follows those changes.
Source difference: preserve the 2023 FAQ’s conflicting wording separately from the explicit 2025 changes and current CDC algorithm.
- The FAQ also conflicts within its own answers: its implementation answer uses hand OR foot for the pass threshold, while its cutoff answer uses both; its immediate-fail answer uses <90% in either site, while its cutoff answer describes <90% in both. The current CDC diagram uses <90% in EITHER site.
- Do not merge these wordings into one threshold or treat the FAQ’s older repeat sequence as the 2025 algorithm. This difference is based on explicit report changes and the current diagram, not publication dates alone.
- The page’s clinical-report header links to newer material, but the FAQ itself says Last Updated July 3, 2023. It is educational content with a statement that it does not necessarily represent official AAP/CDC/HHS views; it is not a newly issued clinical guideline.
Related rule sources & dates
CCHD failed-screen response: stability, consultation and discharge
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · follow-up before discharge · Implementation context
The FAQ describes first examining the infant for hemodynamic stability, then evaluating hypoxemia. Signs or symptoms of CHD call for rapid evaluation and potentially urgent transfer to a center with advanced care.
- For an otherwise well infant with no obvious cause for hypoxemia, consult cardiology or neonatology and obtain an echocardiogram. The FAQ says not to discharge home until the reason for hypoxemia is identified or the hypoxemia has resolved.
- Have a plan where pediatric cardiology/echo are unavailable, potentially telemedicine echocardiography or transfer. Evaluation follows the failed screen before discharge, rather than a scheduled later visit; apparently well infants may deteriorate.
- CDC separately describes immediate pediatrician notification and an echo exception after identification and appropriate treatment of a reversible cause. Those are distinct attributed source conditions, not an app-issued discharge or clearance decision.
Related rule sources & dates
AAP 2025: both-site pass requirement and one retest
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · two explicit algorithm changes · Recommendation
The AAP report explicitly changes the 2011 algorithm to require ≥95% in both preductal and postductal measurements and only ONE retest, replacing the former two-retest allowance.
- These two changes are verified in the primary report’s abstract. The complete clinical-report text and its full uniform dataset were not accessible in this run; do not infer uninspected NICU exceptions or additional details from the abstract.
- The current CDC-hosted diagram supplies the actual hand/foot sites, ≤3-percentage-point difference, <90% immediate-fail branch, one-hour interval and endpoint actions. That local rule is separately attributed to CDC, not claimed verified from the AAP abstract.
Related rule sources & dates
CCHD: clinical documentation and quality checks
AAP-hosted educational FAQ (July 2023) · Implementation context; not the 2025 clinical report.
AAP-hosted educational FAQ · clinical records and program follow-up
Record age at screening, each actual saturation and measured limb, the pass/fail interpretation, screening location, reasons for omission and any subsequent evaluation. Record the final diagnosis when a screen fails.
The FAQ describes clinical-record/log systems, including a clinical identifier, exact measurements and follow-up, and routine audits for missing or misclassified screens. Include applicable state reporting requirements and promptly notify the primary care provider about a missed screen.
More conditions & sources (2) for CCHD: clinical documentation and quality checks
- Missed or misclassified screening should prompt review of the process/root cause, with timely public-health reporting where requested. Keep current cutoffs available in the clinical workflow.
- This is reference information about clinical documentation. NICU Hearts has no patient fields, screening log, identifiers, surveillance database or reporting function and does not collect these data. The complete 2025 report’s new minimum uniform dataset remains unverified here.
Source dates & verification
AAP 2025: uniform program data and screening education
AAP 2025 clinical-report abstract only · Newborn CCHD screening; full-report detail held.
2025 clinical-report abstract · second and third updated recommendations
The 2025 AAP report calls for state programs to collect a recommended minimum uniform dataset and for stakeholder education on screening limitations, non-CCHD conditions and protocol adherence.
These statements are verified from the primary report abstract. The full report’s exact dataset elements, tables and further implementation details remain access-held; older FAQ documentation fields are not represented as that new dataset.
Conditions, related rules & sources for AAP 2025: uniform program data and screening education
- The report identifies improving sensitivity and reducing health inequities as future directions. The directory does not calculate risk, collect patient/program data or implement public-health reporting.
Source dates & verification
Related guidance & reference data
Available here even when another rule is outside your search. Each rule keeps its own supporting bodies and scope.
CCHD: a passing screen does not exclude heart disease
CDC · Healthy-appearing newborns; NICU/other settings after weaning off supplemental oxygen.
History, examination and clinical concern remain important · Safety
Do not use pulse-ox screening as a replacement for complete family history, pregnancy history or physical examination. A passing screen does not exclude all critical or other congenital heart defects.
- The screen can identify hypoxemia from noncardiac conditions as well as CCHD. A result cannot establish the cause of hypoxemia.
- CDC’s pass rule ends screening, not clinical assessment when there are concerns. The AAP-hosted FAQ specifically notes that coarctation can be life-threatening without hypoxemia.
Related rule sources & dates
