Clinical

Neonatal hyperbilirubinemia can recur after successful phototherapy

Last Updated: 2006-01-23 14:35:24 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Neonatal bilirubin levels can rebound after successful phototherapy for hyperbilirubinemia, according to a report in the January 2006 Archives of Disease in Childhood.

Dr. Michael Kaplan from Shaare Zedek Medical Center, Jerusalem, and colleagues investigated the incidence of post-phototherapy rebound hyperbilirubinemia and sought to identify etiological factors that could be used to identify high-risk infants.

Thirty neonates out of 226 studied (13.2%) had post-phototherapy plasma total bilirubin levels that rebounded to at least 256 �mol/L, the authors report.

Twenty-two of these infants were retreated with phototherapy beginning an average 42 hours after discontinuation of the initial phototherapy, the report indicates.

The only factors significantly associated with rebound hyperbilirubinemia were a positive direct Coombs test and a gestational age less than 37 weeks, the researchers note. Rebound was more likely among neonates in whom phototherapy was commenced within 72 hours compared with more than 72 hours after birth.

"In light of our data, we recommend risk assessment in the selection of neonates to be tested for rebound hyperbilirubinemia," the investigators conclude. "Neonates with Coombs positive isoimmunization, borderline prematurity, onset of phototherapy within 72 hours, or a post-phototherapy rate of bilirubin rise greater than expected for age and hours, should be regarded as high risk."

"On our service, we routinely perform a follow up bilirubin test 24 hours following discontinuation of phototherapy," Dr. Kaplan said. "It was this routine which enabled us to determine which babies were at highest risk of significant rebound. I would hope that, as a result of our study, other physicians who do not routinely perform follow up bilirubin testing will start to do so, especially in these high risk groups."

"Babies do not necessarily have to be kept in hospital for follow up studies," Dr. Kaplan said. "If the parents appear reliable, and distances are not too great, the baby can be sent home when the phototherapy has been completed, and brought back the next day. It is unlikely, under the protocol we used, that bilirubin levels will rebound so quickly as to endanger the baby within a 24-hour period."

Arch Dis Child 2006;91:31-34.