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Rebound hyperbilirubinemia in term infants after phototherapy
1Department of Pediatrics, King Abdul-Aziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia. salsaedi@hotmail.com
Insights
In term infants, serum bilirubin levels show a minimal rebound after phototherapy discontinuation. Routine bilirubin monitoring post-phototherapy is not necessary for healthy newborns.
Area of Science:
- Neonatal Medicine
- Pediatric Endocrinology
Background:
- Hyperbilirubinemia is common in term infants.
- Phototherapy is a standard treatment for neonatal hyperbilirubinemia.
- Concerns exist regarding bilirubin rebound after phototherapy cessation.
Purpose of the Study:
- To investigate the incidence and significance of serum bilirubin rebound within 24 hours after discontinuing phototherapy in term infants.
- To evaluate the necessity of post-phototherapy bilirubin monitoring.
Main Methods:
- Retrospective review of medical records of 301 term infants treated with phototherapy.
- Recorded total serum bilirubin (TSB) levels at phototherapy termination and up to 24 hours post-termination.
- Paired t-test used to compare mean TSB levels.
Main Results:
- A statistically significant, though minimal, rebound in mean TSB levels was observed post-phototherapy (P=0.002).
- No significant rebound was found in infants with positive direct Coombs' test results.
- The average follow-up TSB measurement occurred 8.3 hours after phototherapy cessation.
Conclusions:
- Bilirubin rebound after phototherapy in healthy term infants is minimal.
- Routine post-phototherapy serum bilirubin measurement is not clinically indicated.
- Discontinuing routine monitoring can reduce healthcare costs and shorten hospital stays.
Objective:
To determine whether a rebound in serum bilirubin level occurs within 24 hours after discontinuation of phototherapy in term infants with hyperbilirubinemia.
Methods:
A retrospective medical record review of term infants with hyperbilirubinemia requiring phototherapy who were admitted over 24 months, June 1999 to December 2001, at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia was completed. Total serum bilirubin levels (TSB) at and up to 24 hours after termination of phototherapy (follow-up levels) were recorded. The difference between mean TSB level at termination of phototherapy and at follow-up was calculated using the paired t test.
Results:
Three hundred and one infants, 53% (n=161) were boys, mean standard deviation (SD) for gestational age was 39.4 +/- 1.4 weeks, mean birth weight was 3200 +/- 600 g, mean TSB SD at termination of phototherapy was 193 +/- 46 micromole/liter (micromol/l) and at follow-up was 188 +/- 45 micromol/l for all infants with either positive or negative direct coombs' test results. The difference in mean TSB level at discontinuation of phototherapy and at follow-up was statistically significant, (t=3.12, P=0.002). The mean TSB level at termination of phototherapy was 179 +/- 47 micromol/l and at follow-up was 177 +/- 47 micromol/l for 65 infants with positive direct coombs' test results. This difference was statistically insignificant (t=0.725, P=0.47). The mean time interval between the termination of phototherapy and the measurement of follow-up TSB level was 8.3 +/- 5.3 hour.
Conclusion:
The rebound of bilirubin level after termination of phototherapy in otherwise healthy term infants is minimal; thus measurement of serum bilirubin is not required after termination of phototherapy and adds unnecessary expense, prolongs hospitalization, or both.
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