Bilirubin rebound after intensive phototherapy for neonatal jaundice

Abstract

This study was conducted to determine the incidence and magnitude of post-phototherapy bilirubin rebound in neonates. Subjects included inborn neonates needing phototherapy for hyperbilirubinemia. Standard guidelines were used to start and stop phototherapy. Rebound bilirubin was measured 24+/-6 h after stopping phototherapy. Significant bilirubin rebound (SBR) was defined as post-phototherapy bilirubin level needing reinstitution of phototherapy. Among 245 neonates with hyperbilirubinemia, post-phototherapy bilirubin estimation was done in 232 neonates. A total of 17 (7.3%) neonates developed SBR. In neonates with SBR, bilirubin increased by 2.3 mg/dL (95% CI 1.6-3.0) after stopping phototherapy. Risk factors for SBR included birth at >35 weeks of gestation (RR 4.3, 95% CI 1.5-12.0), birthweight <2000 g (RR 3.2, 95% CI 1.0-10.3) and onset of jaundice at >60 h of age (RR 3.3, 95% CI 1.2-9.0). Post-phototherapy discharge and follow-up planning should take into account these risk factors.

Accuracy of transcutaneous bilirubin measurement in newborns after phototherapy

“…Second, it is possible that bilirubin concentration in subcutaneous tissue will rise with a time delay in the case of rebound serum bilirubin. 17 On the other hand, taking into account that the risk of bilirubin encephalopathy is associated with the tendency for unbound bilirubin to enter the tissue, 2 transcutaneous bilirubinometry may provide unique information. Data are missing on the use of the Minolta JM-103 device in newborns treated with phototherapy.…”

The Utility of Inpatient Rebound Bilirubin Levels in Infants Readmitted After Birth Hospitalization for Hyperbilirubinemia

“…There is currently a lack of robust data addressing the value of early (<12 hours) inpatient rebound bilirubin levels; much of the previous research used to create the AAP guideline focused on rebound bilirubin levels that were drawn, on average, ≥12 hours from the cessation of phototherapy. [2][3][4][5][6] Although recent research has focused on attempts to improve adherence to AAP guidelines, it is also necessary to provide stronger evidence evaluating the effects of early inpatient rebound bilirubin levels. 7 The present study assessed the clinical utility of rebound bilirubin levels for infants readmitted with hyperbilirubinemia after their birth hospitalization.…”

Do We Have to Obtain Rebound Bilirubin Levels and What is the Optimal Time?

“…This situation brings forth a discussion on whether to re-check bilirubin levels after phototherapy has been stopped. As the results of the studies about this dilemma are assessed, there is still no consensus about this subject (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The American Academy of Pediatrics (AAP) recommends to measure bilirubin levels within 24 hours after cessation of phototherapy only in cases caused by hemolysis or in those who needed phototherapy in the first three to four days of life (2).…”