A 3-day-old term neonate has serum total bilirubin of 22 mg/dL. Phototherapy was started at 24 hours and has been ongoing for 2 days. The next step in management at this bilirubin level in a term, otherwise healthy newborn at 72 hours is:
- A Immediate exchange transfusion regardless of clinical condition
- B Continue phototherapy; exchange transfusion threshold is 25 mg/dL at 72 hours for term infants ✓
- C Discontinue phototherapy; level is within safe limits at 72 hours
- D Add IVIG and continue phototherapy
Correct answer: B. Continue phototherapy; exchange transfusion threshold is 25 mg/dL at 72 hours for term infants
Explanation
Per AAP 2022 guidelines for term, otherwise healthy (low-risk) neonates at 72 hours of age, exchange transfusion is indicated when total serum bilirubin reaches approximately 25 mg/dL (the exact threshold is based on neurotoxicity risk nomogram). At 22 mg/dL, intensive phototherapy should continue with close monitoring every 4–6 hours. IVIG is indicated in isoimmune hemolytic disease (positive Coombs) when the bilirubin is rising despite phototherapy, not in all cases.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.