Previous table was ~0.5-1.0 mg/dL below the published Bhutani 1999
nomogram at every reference point, which pushed borderline patients
into the next-higher zone. Coarse 12-hour granularity made the
interpolation error worse between reference points.
Corrected to the PediTools-vetted values (same source we use for
AAP 2022) with 6-hour granularity. Source: Bhutani VK et al.,
Pediatrics 1999;103(1):6-14.
Example: 41h of life, TSB 9.7 mg/dL
Before: p75=9.33 → TSB above p75 → "High-Intermediate Zone" (wrong)
After: p75=10.25 → TSB below p75, above p40 → "Low-Intermediate Zone"
(matches the published nomogram)
No code-path changes — only the lookup data.
Replaced "Phototherapy" with the clinical abbreviation "Photo Tx"
(fits in the right margin without cut-off). Exchange label stays.
Bumped the layout right-padding from 40 px to 88 px so even the
longest label ("95th (High-Risk)" on the Bhutani chart) prints
fully inside the canvas on narrow viewports.
Pure visual improvements to renderBiliChart. Interpolation, lookup
tables, and threshold math are all untouched.
AAP chart now has three-zone shading matching BiliTool's convention:
- Faint green tint below the phototherapy curve (safe zone)
- Amber band between phototherapy and exchange (treatment zone)
- Unshaded above the dashed crimson exchange line (danger)
Phototherapy line: solid orange 2.4 px; Exchange: dashed crimson.
renderBiliChart common improvements:
- Right-edge label on each threshold line ("Phototherapy", "Exchange",
or "95th (High-Risk)" for Bhutani) with white halo — identifiable
without a legend, like PediTools
- Legend removed (replaced by the inline labels)
- X-axis auto-ranges to fit the actual data with tick every 12 h
- Y-axis tick every 5 mg/dL for clean BiliTool-style gridlines
- 40 px right padding so labels don't clip
- Patient dot shrunk from r=8 to r=5 with a 1.8 px white ring,
redrawn on top of every label + its TSB value printed next to it
- Bhutani chart inherits all the same improvements without changing
its own zone/fill setup
Reduces label crowding at the chart extremes. Clinical meaning
preserved: 3rd and 97th remain as the abnormal-threshold dashed
outermost lines, 10/25/50/75/90 give the mid trend. The bidirectional
label spread, leader lines, and dot-on-top rendering from the prior
pass all still apply to the 7-line layout.
Fills updated for new indexes (3↔97, 10↔90, 25↔75).
Labels at the top (97/95/90) crowd just as much as the bottom
trio — prior forward-only pass only spread the bottom. Now:
- Forward pass pushes items DOWN when crowded from above
- Backward pass pulls items UP when still crowded from below
- Min gap bumped 13 → 15 px for breathing room
- Labels clamped to stay inside chart top/bottom
- Thin leader line drawn from native curve position to the label
when the two diverge by more than 2 px, so you can still see
which line a nudged label belongs to
- Patient dot redrawn on top of all labels at the very end of
the plugin so a top-region label can never cover the dot
(Chart.js's afterDatasetsDraw fires after dataset rendering,
so the native dot was being painted over).
Label plugin rewritten:
- Collect all percentile-line labels with their native screen Y
- Sort top-to-bottom (97th ... 3rd) so order is always correct
- Walk the sorted list and enforce 13px min vertical gap by
pushing down (never reordering)
- Second-pass pull-back if the stack would clip off the chart
bottom
Prior logic could nudge "10th" past "3rd" because it moved labels
independently without respecting their natural screen order.
Patient dot: radius 8 → 5 (hover 11 → 7). The 8px ring was
dominating the chart; 5px is still clearly visible with the 1.8px
white border but no longer obscures adjacent curves.
Reverted from the 7-line reduced set back to the full clinical set:
3rd, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97th — matching what
Epic and the printed AAP/CDC/WHO charts display.
Kept the mobile-readability improvements from the prior pass:
- Each percentile is a distinct hue (red / deep-orange / orange /
amber / green / blue / violet / purple / pink)
- Outer 3rd + 97th are dashed (abnormal-threshold convention); 5th
and 95th use a tighter dash; rest solid
- 50th remains bold green to anchor the center
- Label plugin's white halo + vertical nudge keeps 3/5/10 and
90/95/97 label stacks legible
- Patient dot still on top, white-ringed
Fill bands updated for 9 indexes (3↔97, 5↔95, 10↔90, 25↔75).
Reduced reference curves from 9 to 7 (dropped 5th and 95th — they
crowd the 3rd/10th and 90th/97th labels on small screens without
adding clinical value; 3rd and 97th are the US/WHO standard
abnormal thresholds).
Each percentile now gets a distinct hue:
3rd red 50th green (bold) 90th violet
10th orange 75th blue 97th pink
25th amber (3rd/97th dashed)
Label plugin improvements:
- Bolder 11px font (was 10px)
- White halo stroke behind text so labels stay legible when the
line they sit on is also colored
- Vertical nudge when two labels would overlap — keeps adjacent
percentiles readable on mobile aspect ratios
- Solid fill color (strips alpha from borderColor)
Patient dot:
- Moved to order: -1 (drawn on top of everything, including labels
and fill bands)
- White 2.5px border ring so it's visible even when it lands
exactly on a colored curve
- Slightly larger hover radius (11 → was 10)
Adds a Chart.js plugin that draws the percentile label at the right
end of each reference line, matching the convention on printed
WHO/CDC growth charts. Lets clinicians identify lines at a glance
without using the legend. Canvas gets 30px right-padding so the
labels don't get clipped.
Percentile displays in growth charts, BMI, and mid-parental height
now show 2 dp (e.g. "37.42th") instead of 1 dp ("37.4th") for more
precision at tail percentiles.
Previously any form of zero total ("0 days", all blank) rejected
with "Enter age". Newborns at birth are a legitimate entry —
distinguish blank-all (error) from explicit-zero (valid).
Replace single text input with three number fields — years, months,
days — that all combine into fractional months. Fill any subset:
leave years blank for a newborn, leave months blank for "2 years",
enter just days for a 10-day-old.
Live hint below ("= 2 yr 5 mo (29 mo total)") still shows the
interpreted total. Parser from prior commit retained on window
for reuse elsewhere.
Replace [years] + [months dropdown] with a single text field that
accepts:
3y / 3 years / 3 yr
29m / 29 months / 29 mo
2y5m / 2 years 5 months / 2 yr 5 mo
3.5 years / 36 (plain number = months)
15 days / 2 weeks / 3y 2m 10d
Enables fractional ages so newborns can be plotted accurately
(WHO/CDC growth curves are continuous — "0 months" means at birth,
not a 0-27 day bucket, so a 15-day-old should plot at ~0.5 months).
Live hint below the field shows how the input was interpreted
("= 2 yr 5 mo (29 mo total)").
Exchange transfusion data (AAP 2022) now covers GA 35, 36, and 38+ weeks
with and without risk factors, hour-by-hour from 12-96h (510 more data
points). Total bilirubin data: 1020 data points (6 photo + 6 exchange
tables x 85 hours each). No interpolation needed for any hour.
Replace interpolated thresholds with exact hour-by-hour values
extracted from PediTools API for every hour from 12-96h:
- 6 phototherapy tables (GA 35/36/38 x with/without risk factors)
- 85 data points per table = 510 total values
- No interpolation needed — exact AAP 2022 nomogram values
- Exchange transfusion thresholds for GA 38 (with/without risk)
Phototherapy thresholds updated with exact values extracted from
PediTools (validated against AAP 2022 nomograms):
- Separate tables for GA 35, 36, and 38+ weeks
- With and without neurotoxicity risk factors
- Hour-specific values at 12, 24, 36, 48, 60, 72, 84, 96, 120h
Previous approximations were 1-3 mg/dL too low (conservative but
inaccurate). New values match the published AAP 2022 curves exactly.
Exchange transfusion thresholds added for GA 38+ weeks (with/without
risk factors). Displayed alongside phototherapy threshold in results.
GA selection expanded: 35, 36, 37, 38, 39, 40+ weeks.
Chart now shows both phototherapy and exchange transfusion lines.
Also: fixed Loki port conflict (3100->3101), added logs.pedshub.com.
GCS Calculator:
- Child/Adult and Infant versions with toggle
- Eye opening (4), Verbal (5), Motor (6) dropdowns
- Auto-calculates total score with severity classification
(Mild 13-15, Moderate 9-12, Severe/Coma 3-8)
- Infant-modified verbal and motor scales per Kids Kard
- Updates on every dropdown change (no button needed)
Equipment Sizing (Johns Hopkins Kids Kard):
- Select age/weight group (premie through 16+)
- Shows: BVM, oral/nasal airway, blade, ETT, LMA, Glidescope,
IV catheter, central line, NGT/OGT, chest tube, Foley
- All values from Johns Hopkins Children's Center Kids Kard
- ETT formulas shown as reference
Replace static vital signs table with interactive age group dropdown.
Each selection shows: HR (awake/sleeping), RR, SBP, DBP, temperature,
SpO2 target, weight range, and age-specific clinical notes.
10 age groups: preterm through 18 years. Values from Harriet Lane
Handbook 23rd Edition. Includes AAP 2017 BP classification thresholds
for ages 13+, ETT sizing formulas, and clinical pearls (orthostatic
testing, febrile tachycardia, athletic bradycardia, etc.).
Full reference table preserved as collapsible "View All Age Groups".
New feature: after generating any clinical note, the app automatically
suggests relevant billing codes displayed as clickable chips below the output.
Backend (src/routes/billing.js):
- POST /api/suggest-codes endpoint analyzes note text
- Extracts diagnoses from Assessment section via regex
- Looks up ICD-10 codes: local common pediatric map (40+ conditions)
first, then NLM Clinical Tables API for unknown terms
- Suggests CPT E/M codes based on note type, visit complexity,
ROS/PE system counts, and MDM level estimation
- Supports: outpatient (new/established), well visit (age-based),
ED, inpatient (admit/subsequent/discharge)
Frontend (public/js/app.js):
- suggestBillingCodes() renders collapsible card with ICD-10 and CPT chips
- Click any chip to copy the code to clipboard
- Shows E/M level assessment (diagnosis count, ROS, PE, MDM complexity)
- Disclaimer: "Suggestions only. Always verify codes."
Integration: called after note generation in all 6 tabs
(encounter, SOAP, sick visit, well visit, hospital course, chart review)
Calculators tab with 7 tools:
- BP Percentile (AAP 2017) with age/sex/height classification
- BMI Percentile (CDC 2000) with extended obesity classification
(Class 1/2/3 using % of 95th percentile per CDC 2022)
- Growth Charts: weight-for-age, length-for-age, head circumference,
weight-for-length (WHO/CDC LMS), Fenton preterm (22-50 weeks)
- Bilirubin: AAP 2022 phototherapy threshold + Bhutani nomogram
with Nelson Table 137.1 risk factors for severe hyperbilirubinemia
- Vital Signs by Age (Harriet Lane) with quick reference formulas
(estimated weight, min SBP, ETT size, maintenance fluids 4-2-1)
- Body Surface Area (Mosteller formula)
- Weight-Based Dosing with max cap and volume calculation
Fix growth chart sub-tab navigation (pills scoped separately from
top-level nav to prevent panel disappearing)
