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Threshold for initiation of phototherapy in infants with non-haemolytic hyperbilirubinaemia
Insights
Initiating phototherapy for infant jaundice at lower bilirubin levels (170 mumol/l) led to more infants receiving treatment compared to higher thresholds (257 or 300 mumol/l). However, outcomes like hospital stay and bilirubin levels remained similar across groups.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Clinical Chemistry
Background:
- Physiological jaundice is common in term infants.
- Hyperbilirubinaemia can lead to complications if untreated.
- Current guidelines recommend initiating phototherapy at specific bilirubin concentrations.
Purpose of the Study:
- To evaluate the effect of initiating phototherapy at different bilirubin concentrations in term infants with physiological jaundice.
- To compare treatment rates, peak bilirubin levels, and complications across different phototherapy initiation thresholds.
Main Methods:
- A study involving 98 clinically jaundiced term infants.
- Infants were divided into three groups, with phototherapy initiated at bilirubin levels of 170 mumol/l (Group A), 257 mumol/l (Group B), and 300 mumol/l (Group C).
- Data collected included days in hospital, entry and exit bilirubin levels, phototherapy usage, peak bilirubin levels, and complications.
Main Results:
- No significant differences in hospital days or bilirubin levels at study entry/exit were observed between groups.
- A much higher percentage of infants in Group A (97%) received phototherapy compared to Group B (47%) and Group C (18%).
- Peak bilirubin levels were higher in Group C infants receiving phototherapy (318 mumol/l) compared to Group A (229 mumol/l) and Group B (282 mumol/l). Two infants in Group C experienced hyperbilirubinaemia complications. Rebound hyperbilirubinaemia was observed in infants with more severe jaundice post-phototherapy.
Conclusions:
- Initiating phototherapy at lower bilirubin thresholds (170 mumol/l) results in higher treatment rates without altering clinical outcomes or hospital stay.
- The threshold for toxicity in non-haemolytic hyperbilirubinaemia might be higher than the commonly accepted 340 mumol/l.
- Phototherapy initiation in term infants with hyperbilirubinaemia will continue at levels >257 mumol/l pending further research.
Abstract:
The effect of initiating phototherapy at three different bilirubin concentrations in infants with physiological jaundice was studied in 98 clinically jaundiced term infants. Phototherapy was initiated at levels of 170, 257 and 300 mumol/l in groups A, B and C respectively. There was no difference between the groups in terms of days in hospital and bilirubin levels at entry or at exit from the study. Of group A, 97% received phototherapy v. 47% and 18% in groups B and C respectively. Peak bilirubin in those infants in group C receiving phototherapy was 318 mumol/l v. 282 mumol/l and 229 mumol/l in groups A and B. Two group C infants suffered complications of hyperbilirubinaemia. Rebound hyperbilirubinaemia was noted in infants with more severe jaundice after cessation of phototherapy. The threshold for toxicity in non-haemolytic hyperbilirubinaemia may be higher than the still widely accepted 340 mumol/l value, but pending definitive studies phototherapy will continue to be initiated at levels of greater than 257 mumol/l in term infants with hyperbilirubinaemia.