Discontinue phototherapy when serum bili reaches 13-14 mg/dLIf bilirubin does not decrease with phototherapy, evaluate for other causes of jaundiceIn difficult isoimmune hemolytic disease, consult Neonatology
When to stop phototherapy for hyper bilirubin?
Following the initiation of phototherapy, only serum bilirubin (TSB) levels are recommended. Stop phototherapy once serum bilirubin has fallen to a level at least 3 mg/dL below the phototherapy threshold. Rebound levels at 6 hours are not predictive of subsequent repeat phototherapy.
What are the treatment options for hyperbilirubinemia?
Hyperbilirubinemia may have different reasons, in the case of severe liver involvement without options for biliary drainage, active and tolerable systemic treatment may reduce tumor burden and alleviate symptoms. By contrast, hyperbilirubinemia due to extrahepatic cholestasis may be managed by drainage and bilirubin will recover over time.
When is follow-up indicated in the workup of hyperbilirubinemia?
If extenuating circumstances result in the discharge of a neonate prior to 16 hours of life, appropriate follow-up for evaluation of hyperbilirubinemia should be arranged. Total bilirubin levels should be plotted on the hour-specific nomogram to direct follow up (Figures 4-7). higher when interpreting the results.
What is the aim of this guideline on neonatal hyperbilirubinemia?
The aim of this guideline is to reduce the incidence of severe neonatal hyperbilirubinemia and bilirubin encephalopathy, and at the same time to minimise the risk of unintended side effects.
When should phototherapy be stopped?
Phototherapy will be stopped when the bilirubin levels fall to a safe level, which usually takes a day or two. Phototherapy is generally very effective for newborn jaundice and has few side effects.
How long is treatment for jaundice?
Jaundice usually clears up within 2 weeks in formula-fed babies. It may last for more than 2 to 3 weeks in breastfed babies. If your baby's jaundice lasts more than 3 weeks, talk to his health care provider.
When can I stop checking my bilirubin?
TSB Monitoring During Intensive PhototherapyTSB level (mg per dL [μmol per L])Repeat TSB20 (342) to 253 to 4 hours14 (239) to less than 204 to 5 hoursContinues to decrease8 to 12 hoursLess than 14Discontinue phototherapy; consider rebound TSB level 24 hours after discontinuation1 more row•May 1, 2008
How long does it take for bilirubin to normalize?
Bilirubin levels slowly improve over 3–12 weeks.
What level of bilirubin requires phototherapy?
Phototherapy should be instituted when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours.
Can bilirubin come back after phototherapy?
Bilirubin levels may rise again 18 to 24 hours after stopping phototherapy. Although rare, this requires follow-up for those who may need more treatment. Side effects — Phototherapy is very safe, but it can have temporary side effects, including skin rashes and loose stools.
When should I get rebound bilirubin?
Conclusions It is not necessary to keep infants in the hospital to check for rebound. However, for infants who require phototherapy during their birth hospitalization and for those with significant hemolytic disease, we recommend obtaining a follow-up bilirubin level 24 hours after discharge.
What level of jaundice is too high?
Usually it is mild. The level of bilirubin that is harmful is around 20. Reaching a level this high is rare. High levels need to be treated with bili-lights.
When do you repeat bilirubin after phototherapy?
Stop phototherapy once the serum bilirubin level is 2.9 mg/dL (50 µmol/L) below the phototherapy threshold, and repeat bilirubin measurement 12 to 18 hours after phototherapy is stopped.
Can bilirubin levels return to normal?
In most cases, higher bilirubin levels will lead to jaundice between 1 and 3 days after birth. Bilirubin levels can peak as high as 18 mg/dL in the fourth or fifth day, and the jaundice typically clears up within 2 weeks as the liver matures.
What level of bilirubin can cause brain damage?
Kernicterus is likely to occur when serum levels of unconjugated bilirubin are greater than 30 mg/dl and is unlikely to occur when levels are lower than 20 mg/dl. The areas of the brain damaged by bilirubin toxicity are the basal ganglia, hippocampus, cerebellum, and nuclei of the floor of the fourth ventricle.
How long does it take bilirubin to come down in adults?
Your body needs at least 6 months to recover from Jaundice. This time is needed by the liver to regain its efficacy. Routine tests are done to check the working of the liver and the enzymes that are created by them. This type of jaundice known as physiologic jaundice.
BACKGROUND
In October 1994, the Provisional Committee for Quality Improvement and Subcommittee on Hyperbilirubinemia of the American Academy of Pediatrics (AAP) produced a practice parameter dealing with the management of hyperbilirubinemia in the healthy term newborn.
DEFINITION OF RECOMMENDATIONS
The evidence-based approach to guideline development requires that the evidence in support of a policy be identified, appraised, and summarized and that an explicit link between evidence and recommendations be defined.
BILIRUBIN ENCEPHALOPATHY AND KERNICTERUS
Although originally a pathologic diagnosis characterized by bilirubin staining of the brainstem nuclei and cerebellum, the term “kernicterus” has come to be used interchangeably with both the acute and chronic findings of bilirubin encephalopathy.
FOCUS OF GUIDELINE
The overall aim of this guideline is to promote an approach that will reduce the frequency of severe neonatal hyperbilirubinemia and bilirubin encephalopathy and minimize the risk of unintended harm such as increased anxiety, decreased breastfeeding, or unnecessary treatment for the general population and excessive cost and waste.
PRIMARY PREVENTION
In numerous policy statements, the AAP recommends breastfeeding for all healthy term and near-term newborns. This guideline strongly supports this general recommendation.
SECONDARY PREVENTION
RECOMMENDATION 2.0: Clinicians should perform ongoing systematic assessments during the neonatal period for the risk of an infant developing severe hyperbilirubinemia.
TREATMENT
RECOMMENDATION 7.1: Recommendations for treatment are given in Table 3 and Figs 3 and 4 (evidence quality C: benefits exceed harms). If the TSB does not fall or continues to rise despite intensive phototherapy, it is very likely that hemolysis is occurring. The committee’s recommendations for discontinuing phototherapy can be found in Appendix 2.
