Newborn Hyperbilirubinemia Phototherapy vs RBTO Stable Patient

Initiate phototherapy when TSB exceeds the AAP 2022 hour‑specific threshold for gestational age/risk factors; it safely lowers bilirubin within 4–6 hours and prevents progression toward exchange transfusion 1 [Level I evidence].
Reserve exchange transfusion (RBTO) for TSB at/above the exchange threshold or within 0–2 mg/dL below it, or when TSB rises despite intensive phototherapy—used to rapidly prevent kernicterus in severe cases 2 [Level II evidence].

Start phototherapy promptly at guideline thresholds; reserve red‑blood‑cell exchange only when TSB reaches or approaches exchange levels or fails to fall with intensive light. Phototherapy is highly effective and safe, preventing bilirubin rise and rarely requiring exchange (non‑inferior across trials; 93% efficacy vs 90% conventional 1). Exchange carries small but real risks (mortality 3–4/1000 2). Caution: rapid TSB rise, hemolysis, or ≥5 mg/dL above exchange threshold markedly increases CP risk 3.