Hyperbilirubinemia in Premature Infants <35 Weeks’ Gestation: A Chronologic Age Format for Graphing Consensus Guidelines

Hyperbilirubinemia in Premature Infants <35 Weeks’ Gestation: A Chronologic Age Format for Graphing Consensus Guidelines | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Hyperbilirubinemia in Premature Infants <35 Weeks’ Gestation: A Chronologic Age Format for Graphing Consensus Guidelines Robert Stavis, Jack Guida This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8875195/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Consensus guidelines for the management of hyperbilirubinemia in premature infants <35 weeks’ gestation were published in 2012 in response to a request from the American Academy of Pediatrics (AAP). The recommendations were specified according to corrected gestational age (CGA) and are the basis for the widely used graphical tool Premie BiliRecs (PBR). In contrast to the original tabular specifications, the PBR implementation limits decision support to infants with a CGA ≥27 weeks who are ≥48 hours old. This work describes a chronologic age-based graphical format to display the 2012 guidelines according to gestational age at birth, using a design similar to AAP guidelines for infants ≥35 weeks’ gestation. Intended for implementation in an electronic health record, this format addresses limitations of PBR and expands decision support from birth to all premature infants <35 weeks’ GA. Direct comparison with similarly formatted international and institutional guidelines demonstrates similarities and differences among recommendations. Health sciences/Risk factors Health sciences/Diseases/Neurological disorders/Brain injuries Hyperbilirubinemia premature gestational age phototherapy clinical decision support Full Text Additional Declarations Yes there is potential conflict of interest. Supplementary Files SupplementalFigures.pdf SUPPLEMENTAL FIGURES Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: revise 09 Mar, 2026 Review # 2 received at journal 04 Mar, 2026 Review # 1 received at journal 04 Mar, 2026 Reviewer # 2 agreed at journal 19 Feb, 2026 Reviewer # 1 agreed at journal 18 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Submission checks completed at journal 16 Feb, 2026 First submitted to journal 13 Feb, 2026 Editor assigned by journal 13 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8875195","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":593007657,"identity":"1f4b6490-9391-44c4-91ff-a66551c9df32","order_by":0,"name":"Robert Stavis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYFACHijJ3gCkDCyI1HIARPIcAGmRIF4LA4NEApgkrMG8vffw5w81h2XkZz6/uuFHgQQDf3t3Al4tMmfOpUkcOHaYx+B2TtnNHqDDJM6c3YBXi4REjhnDAbY0HgPpnLQbPEAtBhK5BLUYfzjwL41HfuaZtJt/iNRiIHGwzYaH4Qb7sdvE2cID9MvZPhsegzM5bLdlDCR4CPuFvffwh4pvEvby7cef3Xzzx0aOv70XvxYkwGMAJolVDgLsD0hRPQpGwSgYBSMIAABUg0TFxlLdyAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-4485-0528","institution":"Consultant in Neonatology","correspondingAuthor":true,"prefix":"","firstName":"Robert","middleName":"","lastName":"Stavis","suffix":""},{"id":593007658,"identity":"54750a91-d567-48fa-b8be-7d0bc2c3a8fa","order_by":1,"name":"Jack Guida","email":"","orcid":"","institution":"Children’s Hospital of Philadelphia","correspondingAuthor":false,"prefix":"","firstName":"Jack","middleName":"","lastName":"Guida","suffix":""}],"badges":[],"createdAt":"2026-02-13 20:15:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8875195/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8875195/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103504147,"identity":"3d90d13f-0d8f-4dea-896e-e75a4e4a3986","added_by":"auto","created_at":"2026-02-26 13:17:51","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1176444,"visible":true,"origin":"","legend":"","description":"","filename":"BiliGraphstext.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8875195/v1_covered_ab5f3a65-3e18-4939-8399-d537c1b52ef1.pdf"},{"id":103064883,"identity":"cedff4d3-8cef-4444-a9b0-38000948d953","added_by":"auto","created_at":"2026-02-20 11:02:34","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":1795638,"visible":true,"origin":"","legend":"SUPPLEMENTAL FIGURES","description":"","filename":"SupplementalFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8875195/v1/8b4250b955858c003f9a9ec4.pdf"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential conflict of interest.","formattedTitle":"Hyperbilirubinemia in Premature Infants \u003c35 Weeks’ Gestation: A Chronologic Age Format for Graphing Consensus Guidelines","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-perinatology","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"jp","sideBox":"Learn more about [Journal of Perinatology](http://www.nature.com/jp/)","snPcode":"41372","submissionUrl":"https://mts-jper.nature.com/cgi-bin/main.plex","title":"Journal of Perinatology","twitterHandle":"@jperinatology","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Hyperbilirubinemia, premature, gestational age; phototherapy, clinical decision support","lastPublishedDoi":"10.21203/rs.3.rs-8875195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8875195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Consensus guidelines for the management of hyperbilirubinemia in premature infants \u003c35 weeks’ gestation were published in 2012 in response to a request from the American Academy of Pediatrics (AAP). 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