{
  "id": "medical/neonatal-bilirubin-nomogram",
  "signature": "AI applies adult bilirubin nomogram to a preterm neonate, missing need for exchange transfusion",
  "signature_zh": "AI将成人胆红素列线图应用于早产儿，错过换血指征",
  "regex": "(?i)(neonat|newborn|preterm|premature).*(bilirubin|jaundice).*(nomogram|threshold|exchange transfusion|phototherapy)",
  "domain": "medical",
  "category": "runtime_error",
  "subcategory": null,
  "root_cause": "Neonatal hyperbilirubinemia management uses gestational-age- and hour-of-life-specific nomograms (e.g., AAP Bhutani nomogram); adult bilirubin thresholds are orders of magnitude lower and inappropriate for newborns.",
  "root_cause_type": "generic",
  "root_cause_zh": "新生儿高胆红素血症管理使用基于胎龄和出生小时数的特定列线图（如AAP Bhutani列线图）；成人胆红素阈值低数个数量级，不适用于新生儿。",
  "versions": [
    {
      "version": "AAP Bhutani Nomogram 2022",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "NICE Guideline CG98 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "BiliTool 2.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "NeoFax 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Direct hyperbilirubinemia (conjugated) requires different workup for biliary atresia or hepatitis; indirect drives kernicterus risk.",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "This would trigger unnecessary phototherapy in nearly all newborns, wasting resources and separating mother-infant dyads.",
      "fail_rate": 0.95,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Bilirubin neurotoxicity risk depends on gestational age and postnatal hours; weight alone is insufficient.",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Use the AAP-endorsed Bhutani nomogram (https://www.aap.org/bilitool) with the infant's gestational age in weeks, hour of life, and measured total bilirubin. Plot the value to determine phototherapy or exchange transfusion threshold. Document the nomogram version used.",
      "success_rate": 0.92,
      "how": "Use the AAP-endorsed Bhutani nomogram (https://www.aap.org/bilitool) with the infant's gestational age in weeks, hour of life, and measured total bilirubin. Plot the value to determine phototherapy or exchange transfusion threshold. Document the nomogram version used.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If Bhutani nomogram unavailable, use the rule of thumb: phototherapy at total bilirubin (mg/dL) = gestational age (weeks) × 0.5 for first 72 hours, but this is less accurate. Always consult local NICU protocol.",
      "success_rate": 0.78,
      "how": "If Bhutani nomogram unavailable, use the rule of thumb: phototherapy at total bilirubin (mg/dL) = gestational age (weeks) × 0.5 for first 72 hours, but this is less accurate. Always consult local NICU protocol.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "使用AAP认可的Bhutani列线图（https://www.aap.org/bilitool），输入婴儿的胎龄（周）、出生后小时数和实测总胆红素。根据结果确定光疗或换血阈值。记录使用的列线图版本。",
    "如果无法获取Bhutani列线图，可使用经验法则：前72小时内光疗阈值（mg/dL）= 胎龄（周）× 0.5，但此方法准确性较低。务必咨询当地NICU方案。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.aap.org/en/patient-care/newborn-care/management-of-hyperbilirubinemia-in-the-newborn-infant-35-or-more-weeks-of-gestation/",
  "official_doc_section": null,
  "error_code": "NEONATAL-BILI-NOMOGRAM-ERR",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.85,
  "resolvable": "true",
  "first_seen": "2024-06-10",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}