EFFICACY OF INTENSIFIED PHOTOTHERAPY AND ORAL HYDRATION IN EXTREME NEONATAL JAUNDICE. 1848

Abstract

Background: Early discharge of mothers and infants from maternity hospitals has become much more frequent in recent years. In the follow-up of such infants jaundice may be overlooked or underestimated. Increasing numbers of infants are now being readmitted to hospitals with extreme jaundice.Material and results: We report on three infants (4, 6, and 6 days old) who where admitted for serum bilirubin levels of >30 mg/dL (=510μmol/L). In one of them unrecognized Rhesus immunization was the cause of the hyperbilirubinemia, while in the two others increased enterohepatic circulation of bilirubin secondary to low nutrient intake was an important contributory factor. In all three infants intensified phototherapy (11-14μW/cm2/nm) with whole body exposure plus ad lib oral hydration with milk were initiated immediately upon admission to the nursery. After two hours serum bilirubin values were reduced by approximately 10-11 mg/dL (170-185μmol/L) in all of these infants (see figure, arrows indicate the time that phototherapy was discontinued). The planned exchange transfusions were eventually cancelled as serum bilirubin values continued to fall. Discussion: The initial rate of reduction in serum bilirubin observed in these cases (≥5 mg/dL/h [85 μmol/L/h]) was considerably higher than that previously reported in the literature. This experience suggests that in selected infants with extreme jaundice, intensified phototherapy and oral hydration with formula started at the time of admission may reduce the need for exchange transfusions. Even if an exchange transfusion is eventually performed, utilizing this strategy in the waiting period should be beneficial, as both the reduction in serum bilirubin levels as well as the conversion of significant amounts of bilirubin into water soluble isomers should reduce the risk of neurotoxicity.