Phototherapy for neonatal jaundice in infants with cephalhematomas

The efficacy of phototherapy in a group of infants with nonhemolytic hyperbilirubinemia and no cephalhematomas was compared with a second group of infants with large cephalhematomas (> 7 cm across), but similar in all other aspects. The cephalhematoma group demonstrated significantly lower hemoglobin (Hb) and hematocrit (hct) values (P < .0001, P < .002 respectively) than the standard group, even after the latter group had been adjusted by stratification (P < .0001, P < .005) such that the starting bilirubin concentration, birth weight, and gestational age were highly comparable to the cephalhematoma group. The bilirubin concentrations of the cephalhematoma, original, and adjusted groups were 277.8 +/- 5.8 mumol/L (16.24 +/- 0.03 mg/dL), [mean +/- sem], 265.2 +/- 0.5 mumol/L (15.50 +/- 0.03 mg/dL), and 275.2 +/- 0.9 mumol/L (16.09 +/- 0.05 mg/dL), respectively. The postnatal age at the start of phototherapy in the cephalhematoma group was comparable with that of the standard group before and after adjustment. Phototherapy was equally effective in the cephalhematoma and standard (original and adjusted) groups of infants, in terms of duration, 24-hr decline, and overall decline/hr for the duration of exposure. The proportionate 24-hr decline was 24.02 +/- 1.90% vs 20.99 +/- 0.23% and 22.61 +/- 0.48% and overall decline/hr was 0.83 +/- 0.06% vs 0.74 +/- 0.01% and 0.78 +/- 0.01%. We conclude that the sequestrated blood in the cephalhematomas did not significantly interfere with the efficacy of phototherapy.