Newborn Bilirubin Chart – Predicting the Risk of Kernicterus

A newborn bilirubin chart is a way of predicting within the first few hours of life, which babies are most at risk of getting severe hyperbilirubinemia and the subsequent brain damage of kernicterus. The chart is a nomogram, or graph, on which the doctor will calculate the relation between a baby’s bilirubin levels and the baby’s age in hours.

Doctors Can Catch High Bilirubin Levels Early

The nomogram is divided into risk zones: Low Risk Zone, Low Intermediate Risk Zone, High Intermediate Risk Zone, and High Risk Zone. To use the nomogram, the doctor will first check the baby’s bilirubin levels by one of two simple bilirubin tests - total serum bilirubin (TSB), or transcutaneous (TcB). Next, the doctor will plot the bilirubin levels against the newborn’s age in hours to determine whether the baby is in a high-risk or low-risk category.

Newborn Bilirubin Chart Method Is Regarded as Best Practice

According to the American Academy of Pediatrics (AAP), the hour-specific nomogram is the best method for assessing the risk of bilirubin toxicity. The results of the nomogram are known before a newborn is discharged from the hospital. All hospitals should provide written andverbal information to parents at the time of discharge, whichshould include an explanation of jaundice, their baby’s risk level, the need to monitor their child for jaundice, and advice on how monitoring should bedone.

The newborn bilirubin chart is designed for healthy, full-term or near-term babies. In other words, the nomogram is recommended for monitoring newborns with no bilirubin complications that required 1st day phototherapy, and babies with no ABO blood type incompatibility. The nomogram is also not intended to assess premature babies. It should only be used for infants who are born full term (at least 36 completed weeks of gestation) and with a birth weight of at least 2000 g (4.4 pounds).

The AAP recommends:

  • Before discharge, every newborn should beassessed for the risk of developing severe hyperbilirubinemia. This involves measuring the TSB or TcB and plotting it on a nomogram.
  • Appropriate follow-up afterdischarge is essential. Every newborn should be scheduled for a follow-up visit within three to five days of age, when the baby's bilirubin level is highest.

“We Didn’t Know…”

Parents of children with kernicterus brain damage were not informed about the hazards of jaundice and the prevention of kernicterus. We know this, because our clients are those parents. They did not know that the results from a simple, inexpensive test plotted on a newborn bilirubin chart could have prevented their child’s kernicterus-induced cerebral palsy. In a matter of hours, the hospital’s failure becomes a multi-million dollar tragedy for the lifetime of a child.

All of us can and should speak out about the need for patient safety and for a public health policy to better manage the preventable brain damage of kernicterus. As dedicated attorneys, we protect these families in ways that they cannot protect themselves.

We must never forget, kernicterus is preventable, and severe hyperbilirubinemia is both preventable and treatable. We will work tirelessly to protect the rights of these children and their families, and champion their cases against negligent hospitals, doctors, insurance companies and other powerful interests.

Read more about the newborn bilirubin chart in diagnosing kernicterus.

Kernicterus Information Center