Management - Phototherapy
Management
Treatment
Phototherapy
In almost all newborns, phototherapy either decreases or slows the rise of the serum bilirubin, regardless of gestational age, presence or absence of hemolysis or degree of skin pigmentation. It has been repeatedly shown that neonates treated with phototherapy require fewer exchange transfusions. Decades of experience with its use have shown phototherapy to be safe, with no reported serious long-term side effects. Therefore, it should be regarded as the first-line therapy for all unconjugated hyperbilirubinemia that needs to be treated.The mechanisms by which phototherapy reduces serum bilirubin, as well as its complications have been well-described. Despite many years of use, there is no standardized method of delivering phototherapy. Many variables affect the efficacy of phototherapy. Optimization of these factors is what distinguishes intensive phototherapy from conventional. In most circumstances, phototherapy does not need to be continuous; it may be interrupted during feeding or brief parental visits. However, if the bilirubin is approaching the exchange level, phototherapy should be used continuously until the bilirubin falls or the exchange is begun. Home phototherapy may be considered for bilirubin levels 2-3 mg/dL below those indicated in the AAP guidelines. However, as in hospitalized infants, serum bilirubin levels must be monitored regularly. Home phototherapy should NOT be used for any infant with risk factorsOn average, for infants more than 35 weeks gestation, intensive phototherapy results in a decline of the bilirubin level by 30-40% after 24 hours of use. The most significant decline occurs in the first 4-6 hours. Conventional phototherapy usually produces a 5-20% fall in bilirubins by 24 hours. While there is no standard for discontinuing phototherapy, it is usually stopped when the bilirubin falls below 13-14 mg/dL. Follow-up levels within 24 hours of discontinuation is usually recommended in case of rebound.Return to top of page