AAP Clinical Practice Guideline, 2022 revision (it replaces the 2004 version) for infants ≥35 weeks.

• Universal pre-discharge bilirubin (TSB or TcB) for every newborn, plotted on hour-specific phototherapy curves for each gestational week (35, 36, 37, 38, 39, ≥40 wk).
• Two curve sets: with and without neurotoxicity risk factors: GA <38 wk, albumin <3.0 g/dL, isoimmune hemolysis (DAT+), G6PD deficiency or other hemolysis, sepsis, significant clinical instability in the last 24 h.
• Follow-up timing depends on how far the bilirubin is below the phototherapy threshold (not on the Bhutani percentile zone) and on age at discharge.
• TcB: measure TSB if TcB is within 3 mg/dL of the threshold or TcB ≥15 mg/dL.
• Escalation of care when TSB is within 2 mg/dL of the exchange threshold: intensive phototherapy, urgent labs, IV fluids, IVIG 0.5–1 g/kg for isoimmune hemolysis.
• Stop phototherapy when TSB is ≥2 mg/dL below the threshold at which it was started; rebound TSB 6–12 h later (or next day) if hemolysis, <38 wk or started <48 h.

What changed vs 2004

• Thresholds modestly higher (fewer babies treated); GA built into the curves.
• Bhutani nomogram no longer used to decide treatment; home phototherapy allowed in selected well babies; no water/dextrose supplementation.

AAP CPG 2021: well-appearing, term (≥37 wk) infants 8–60 days with temperature ≥38.0 °C. It does not apply to infants <8 days, preterm, ill-appearing, those with a focal bacterial infection, clinical bronchiolitis, immunocompromise, or recent vaccines/antibiotics.

Abnormal inflammatory markers (IMs): procalcitonin >0.5 ng/mL, CRP >20 mg/L (2 mg/dL), ANC >4000/µL (or >5200), temperature >38.5 °C.

What changed

• WBC count is no longer a marker; procalcitonin is preferred.
• Not all infants 29–60 d need an LP; 22–28 d is a middle zone.

Empirical: ≤28 d ampicillin + ceftazidime (or gentamicin); 29–60 d ceftriaxone. Add IV acyclovir if HSV risk (vesicles, seizures, CSF pleocytosis, high ALT, maternal HSV).

AAP CPG 2014 (1–23 months), reaffirmed; RSV immunization updated 2023–2024.

• Diagnosis and severity are clinical: no routine CXR, viral testing or blood tests.
• Do not give salbutamol, epinephrine, systemic steroids, antibiotics (unless bacterial co-infection) or chest physiotherapy.
• Nebulized hypertonic saline: not in the ED; may be used in inpatients expected to stay >72 h.
• Oxygen may be withheld if SpO2 ≥90%; continuous pulse oximetry not required.
• NG or IV isotonic fluids if the infant cannot feed orally.
• Higher risk: <12 weeks, prematurity, CHD, chronic lung disease, immunodeficiency.

RSV prevention (what changed)