Management of neonatal hyperbilirubinemia: rational use of phototherapy

Phototherapy has been used to treat neonatal hyperbilirubinemia for more than three decades; however, it is only during the last ten years that an understanding of the mechanism of action of phototherapy has emerged. While visible light is known to photooxidize and photoisomerize bilirubin, recent data suggest that the formation of bilirubin structural isomers (lumirubin) is responsible for the decrement in serum bilirubin. This paper discusses current clinical recommendations for light dosage and wavelength and develops new guidelines based upon recent information of how light effects a reduction in the serum bilirubin concentration.