Phototherapy For Neonatal Jaundice Research Articles

Effect of phototherapy on serum calcium levels in neonates receiving double surface LED phototherapy for neonatal jaundice

Background: To study the occurrence of hypocalcaemia in neonates with physiological unconjugated hyperbilirubinemia after 48 hours of phototherapy or at the end of phototherapy, in case duration of phototherapy was less than 48 hours. Methods: This prospective study was conducted on 100 term neonates (61 males and 39 females) admitted to Neonatal intensive care unit of Shri B M Patil Medical College and Hospital, Vijayapura, Karnataka with unconjugated hyperbilirubinemia and requiring phototherapy. Total Serum bilirubin levels and serum calcium levels were checked before and after phototherapy. Neonates were assessed for clinical features of hypocalcemia i.e. jitteriness, irritability/excitability, lethargy and convulsions. Results: After phototherapy, there was hypocalcemia in 35.0% neonates. The difference between pre and post phototherapy serum calcium levels were found to be statistically significant (p <0.001). 2.86% of neonates developed jitteriness among those who had hypocalcemia. Hypocalcemia was more in subjects who received phototherapy for longer duration. Conclusions: Hypocalcaemia is a common complication of phototherapy. Therefore, calcium supplementation should be done in all neonates undergoing phototherapy.

History of phototherapy in neonatal jaundice and the likelihood of childhood asthma

Introduction: The increased risk for childhood asthma in children suffering from hyperbilirubinemia, and those who underwent phototherapy has attracted enormous interest. Objectives: In this study, we attempted to explain the relationship between childhood asthma and phototherapy. Patients and Methods: This case-control study was performed on children aged between 2 and 14 years old with a definitive diagnosis of childhood asthma. A sex and age-matched group of children without any pieces of evidence, of asthma or other respiratory problems were also selected as the control group. The hospital’s recorded files were the primary sources for the information about demographics, history of asthma in neonates or his/her parents, history and time of phototherapy as well as the data on neonatal hyperbilirubinemia. Results: In total, 69 children who have asthma and 71 non-asthmatic children as the controls were included in this study. Moreover, these two groups were matched for baseline variables. Comparing the history of phototherapy between the asthmatic and non-asthmatic groups showed a higher rate of phototherapy in the former group (37.7% versus 11.3%; P &lt; 0.001). Accordingly, the risk of asthma could be increased according to the history of phototherapy, up to four times (OR = 4.76, 95%CI: 1.97–11.51, P &lt; 0.001). Conclusion: The risk of childhood asthma can increase if a child had the previous phototherapy. This causal effect is independent of the degree or the age of occurring hyperbilirubinemia, which is the main indication for phototherapy.

High- versus low-dose conventional phototherapy for neonatal jaundice

High- versus low-dose conventional phototherapy for neonatal jaundice

EFFECT OF PHOTOTHERAPY ON SERUM CALCIUM LEVELS IN NEONATAL JAUNDICE IN FULL TERM NEONATES

Introduction: The most prevalent anomalous physical finding during the first week of life is neonatal hyperbilirubinemia (NNH). It is estimated that more than two thirds of newborn babies have acquired clinical jaundice. It was also discovered that in the unconjugated hyperbilirubinemia of most neonates represents a common or exaggerated physiological syndrome. The physical immaturity of infants to handle increased production of bilirubin is referred to as Jaundice. This becomes potentially neurotoxic if severe unconjugated hyperbilirubinemia is left untreated. One of the routine strategies for treating hyperbilirubinemia is known as phototherapy. However it is not a harmless interference. This can produce negative results, such as dehydration, temperature volatility, blood flow redistribution, genotoxicity, rashes on the skin, loose skin, stools, damage to retinas, hypocalcemia and bronze baby syndrome. One of the lesser known but which has a potential adverse effect of phototherapy is hypocalcemia. A total serum calcium concentration of &lt; 7 mg / dl or ionised calcium concentration &lt; 4mg / dl (&lt; 1mol / L) is classified as neonatal hypocalcemia. Hypocalcemia increases the permeability of cells to sodium ions and increases the excitability of cell membranes.&#x0D; Material &amp; Methods: 60 full term neonates were included in present cross sectional study who was admitted to Neonatal Intensive Care Unit (NICU). Full term neonates who completed 37 weeks of gestation with unconjugated hyperbilirubinemia who require phototherapy. Under the normal protocol, traditional phototherapy equipment containing four blue light fluorescent lamps with wavelengths of 410-470 nm was mounted at a distance of 25-35 cm from the skin surface of neonates with entirely covered eyes and genitals. At 15μW / cm2 /nm at the level of the infant's skin, the irradiance during phototherapy was assessed and maintained consistently.&#x0D; Results: Among 60 neonates included in this study there were 27 (45%) male whereas 33 (55%) female neonates. In present study the mean levels of serum calcium before phototherapy was 9.21 with standard deviation of 0.83 while the serum calcium levels after phototherapy were 8.36 with standard deviation of 0.78. There was a statistically significant difference between serum mean calcium levels before and after phototherapy (p=0.001).&#x0D; Conclusion: A major issue is phototherapy induced hypocalcemia. Before beginning and during phototherapy for neonatal jaundice and close monitoring of neonates for signs of hypocalcemia, careful calcium status calculation should be carried out.. After phototherapy, there is a substantial reduction in the amount of serum calcium, but the risk of hypocalcemia in stable full-term neonates is minimal.

Adverse effects of phototherapy on calcium, magnesium and electrolytes levels in neonatal jaundice

Adverse effects of phototherapy on calcium, magnesium and electrolytes levels in neonatal jaundice - IJCBR- Print ISSN No: - 2394-6369 Online ISSN No:- 2394-6377 Article DOI No:- 10.18231/j.ijcbr.2019.061, International Journal of Clinical Biochemistry and Research-Int J Clin Biochem Res

Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions.

A breakthrough discovery 60 years ago by Cremer et al. has since changed the way we treat infants with hyperbilirubinemia and saved the lives of millions from death and disabilities. "Photobiology" has evolved by inquiry of diverse light sources: fluorescent tubes (wavelength range of 400-520 nm; halogen spotlights that emit circular footprints of light; fiberoptic pads/blankets (mostly, 400-550 nm range) that can be placed in direct contact with skin; and the current narrow-band blue light-emitting diode (LED) light (450-470 nm), which overlaps the peak absorption wavelength (458 nm) for bilirubin photoisomerization. Excessive bombardment with photons has raised concerns for oxidative stress in very low birthweight versus term infants treated aggressively with phototherapy. Increased emphasis on prescribing phototherapy as a "drug" that is dosed cautiously and judiciously is needed. In this historical review, we chronicled the basic to the neurotoxic components of severe neonatal hyperbilirubinemia and the use of standardized interventions.

Perinatal risk factors for type 1 diabetes revisited: a population-based register study

Aims/hypothesisSingle-centre studies and meta-analyses have found diverging results as to which early life factors affect the risk of type 1 diabetes during childhood. We wanted to use a large, nationwide, prospective database to further clarify and analyse the associations between perinatal factors and the subsequent risk for childhood-onset type 1 diabetes using a case–control design.MethodsThe Swedish Childhood Diabetes Register was linked to the Swedish Medical Birth Register and National Patient Register, and 14,949 cases with type 1 diabetes onset at ages 0–14 years were compared with 55,712 matched controls born from the start of the Medical Birth Register in 1973 to 2013. After excluding confounders (i.e. children multiple births, those whose mother had maternal diabetes and those with a non-Nordic mother), we used conditional logistic regression analyses to determine risk factors for childhood-onset type 1 diabetes. We used WHO ICD codes for child and maternal diagnoses.ResultsIn multivariate analysis, there were small but statistically significant associations between higher birthweight z score (OR 1.08, 95% CI 1.06, 1.10), delivery by Caesarean section (OR 1.08, 95% CI 1.02, 1.15), premature rupture of membranes (OR 1.08, 95% CI 1.01, 1.16) and maternal urinary tract infection during pregnancy (OR 1.39, 95% CI 1.04, 1.86) and the subsequent risk of childhood-onset type 1 diabetes. Birth before 32 weeks of gestation was associated with a lower risk of childhood-onset type 1 diabetes compared with full-term infants (OR 0.54, 95% CI 0.38, 0.76), whereas birth between 32 and 36 weeks’ gestation was associated with a higher risk (OR 1.24, 95% CI 1.14, 1.35). In subgroup analyses (birth years 1992–2013), maternal obesity was independently associated with subsequent type 1 diabetes in the children (OR 1.27, 95% CI 1.15, 1.41) and rendered the association with Caesarean section non-significant. In contrast to previous studies, we found no association of childhood-onset type 1 diabetes with maternal–child blood-group incompatibility, maternal pre-eclampsia, perinatal infections or treatment of the newborn with phototherapy for neonatal jaundice. The proportion of children with neonatal jaundice was significantly higher in the 1973–1982 birth cohort compared with later cohorts.Conclusions/interpretationPerinatal factors make small but statistically significant contributions to the overall risk of childhood-onset type 1 diabetes. Some of these risk factors, such as maternal obesity, may be amendable with improved antenatal care. Better perinatal practices may have affected some previously noted risk factors over time.

Efficacy of Home Phototherapy in Neonatal Jaundice

Background: Jaundice is one of the most common problems in the neonatal period. Phototherapy is one of the most commonly used treatments for jaundice that can be used as a simple, practical home-based treatment. Hospitalization during the first days of birth to conduct phototherapy may result in problems like nosocomial infections and mother separation from the baby. Objectives: The aim of this study was to evaluate the efficacy of home phototherapy in the duration of treatment, mean bilirubin level, and complications. Methods: This clinical trial was performed on newborns with jaundice in Isfahan health centers. The sample was randomly divided into two groups: Phototherapy at home (32 patients) and phototherapy at the hospital (32 patients). A demographic questionnaire and a researcher-made checklist were used to collect data on variables such as the duration of treatment, the frequency of treatment failure, mean bilirubin, and phototherapy complications. Results: The mean duration of phototherapy in both groups was two days, which showed no significant difference (P = 0.32). The most common complication in both groups was skin rashes and restlessness, which also showed no significant between two groups (P > 0.05). There was no significant difference in terms of treatment failure (P = 0.246). Statistical tests also revealed that bilirubin reduction was the same in both groups. Conclusions: Home phototherapy can be suggested as a safe treatment with no complication to the patients.

New approaches to improve efficacy and reduce side effects of phototherapy for neonatal hyperbilirubinemia using led and laser sources

The article discusses the new opportunities for improving technology of phototherapy for neonatal jaundice using LED and laser sources in order to reduce the level of bilirubin in the blood of infants. It has been shown that several types of LEDs with emission spectrum corresponding to the long-wavelength slope of bilirubin absorption band can be used for therapeutic purposes. At the same time, the efficacy of phototherapy depend on not only from the position of the maximum in emission spectrum of the LEDs within bilirubin absorption band, but also on the spectral width of acting radiation. Based on the study of regularities of infl of optical radiation on the survival of animal cells in culture sensitized with bilirubin it has been concluded that the damaging eff cts are signifi ly reduced upon transition from quasi-monochromatic LED sources to lasers, emitting in the same spectral range. It allows to consider the modern semiconductor lasers emitting in blue and blue-green spectral regions as promising sources for development of phototherapeutic equipment for treating neonatal hyperbilirubinemia.

Sunlight phototherapy for neonatal jaundice-time for its day in the sun?

Sunlight phototherapy for neonatal jaundice-time for its day in the sun?

Yinzhihuang oral liquid combined with phototherapy for neonatal jaundice: a systematic review and meta-analysis of randomized clinical trials

BackgroundNeonatal jaundice affects at least 481,000 newborns every year. Phototherapy is recommended but it’s effects are limited and adverse reactions can occur. In China, phototherapy combined with Yinzhihuang oral liquid is also used for this condition. This systematic review evaluated the effectiveness and safety of combination therapy with Yinzhihuang oral liquid and phototherapy compared to phototherapy alone for treating neonatal jaundice.MethodA comprehensive literature search was performed in four Chinese databases, two English language databases and two trial registries from inception to June 2017. Two authors independently screened the citations and retrieved full publications for randomized trials on Yinzhihuang oral liquid combined with phototherapy for neonatal jaundice. The methodological quality of the trials was assessed according to the Cochrane Collaboration’s tool for assessing risk of bias. Data were analyzed using RevMan 5.3.ResultTotally 17 trials (involving 2561 neonates) were included in this review. Fourteen of them had a high risk of bias. Significant differences were detected between combination therapy and phototherapy alone for serum bilirubin level (MD − 50.25 μmol/L, 95% CI -64.01 to − 36.50, I2 = 98%; 7 trials, post-hoc decision choosing random effects model), failure of jaundice resolution (RR 0.21, 95% CI 0.14 to 0.32, I2 = 0%; 11 trials, fixed effects model), and time to jaundice resolution (MD − 2.17 days, 95%CI -2.96 to − 1.38, I2 = 98%; 6 trials, random effects model). Adverse events were reported in eight trials but none were serious. Trial sequential analysis for serum bilirubin level suggested that the cumulative Z-curve (which represents 1478 participants) reached the required information size (DARIS = 1301 participants).ConclusionBased on trials with low methodological quality, Yinzhihuang oral liquid combined with phototherapy seemed to be safe and superior to phototherapy alone for reducing serum bilirubin in neonatal jaundice. These potential benefits need to be confirmed in future trials using rigorous methodology.Trial registrationSystematic review registration: [PROSPERO registration: CRD42016037691].

Protocolo de enfermería para fototerapia neonatal

Objetivo: Determinar la evidencia disponible en el manejo de fototerapia para el tratamiento de ictericia neonatal para construir un protocolo de enfermería.Método: Revisión bibliográfica exhaustiva, durante el período 2011-2016, realizada a través de búsquedas bibliográficas en PubMed con las palabras clave "neonatal jaundice guidelines", "neonatal jaundice phototherapy"; en Cuiden, con las palabras clave "neonatal jaundice", "neonatal phototherapy”; y en Google Académico con “protocolo” “ictericia neonatal”, “guidelines neonatal jaundice”, “guidelines phototherapy”. No hubo límites en el idioma.Resultado: Desarrollo de un protocolo de enfermería para niños mayores de 35 semanas de edad gestacional tratados con fototerapia, basado en la evidencia de la revisión de la literatura y acordado por todo el personal de enfermería de la unidad.Conclusiones: El cuidado de enfermería es importante para el mantenimiento y el éxito del proceso de fototerapia. Un protocolo acordado, reduce la variabilidad en la práctica y puede mejorar los resultados de fototerapia en neonatos con hiperbilirrubinemia no conjugada.

Phototherapy is commonly used for neonatal jaundice but greater control is needed to avoid toxicity in the most vulnerable infants.

Limited information is available about how guidelines on phototherapy for neonatal jaundice are applied in practice and toxicity is a concern. We studied the use of phototherapy in relation to birthweight and gestational age (GA) in Norwegian neonatal intensive care units (NICUs). The study population was all 5382 infants admitted to the 21 NICUs in Norway between September 1, 2013 and August 31, 2014. Data were recorded daily in the Norwegian Neonatal Network database and anonymised data on patient characteristics, diagnoses, duration, the ages at the start and discontinuation of phototherapy were analysed. More than a quarter (26.6%) of all infants admitted to Norwegian NICUs during the study period received phototherapy. The use of phototherapy was inversely related to GA and birthweight. More than 80% of the preterm infants under 28 weeks of GA received phototherapy. The duration was significantly longer in the lowest birthweight and GA groups and decreased with increasing birthweight and GA. Phototherapy is proved to be a strong candidate for the most common therapeutic modality in NICU infants. However, in the light of reported toxicity in the smallest, most vulnerable infants, we recommend increased emphasis on quality control.

Uniform national guidelines do not prevent wide variations in the clinical application of phototherapy for neonatal jaundice.

This study compared the use of phototherapy for neonatal jaundice in all 21 Norwegian neonatal intensive care units (NICUs) from 2013-2014 to improve practice. Information on all types of phototherapy devices was collected, and irradiance was measured from random units at 20 cm and 50 cm from the light source. We gathered information on local practice rules, including the use of single, double or triple phototherapy, how infants were positioned, the frequency of blood sampling, rules for using reflective surfaces and interrupting phototherapy. In every NICU, we asked one nurse with more than five years of experience and one with less than one year to set up phototherapy equipment, then measured the irradiance and distance. Photodiodes were the most common of the eight types of phototherapy devices used. Rules for the distance from the device to the infant varied from 10 to 40 cm and in practice they varied from 15 to 48 cm, with irradiance ranging from 11.1-56.1 W/m2 . There were significant variations between NICUs with regard to the overall treatment duration and duration in most birthweight categories. There were considerable variations in phototherapy practices among Norwegian NICUs. In particular, the significant variations in duration need to be addressed.

Ocular findings on follow-up in children who received phototherapy for neonatal jaundice

BackgroundTo evaluate the ocular findings in children between 3 and 5 years of age who had received phototherapy in the neonatal period and to investigate whether they had phototherapy-related permanent ocular damage clinically. MethodsThe phototherapy group (n = 57) consisted of children who had undergone phototherapy for at least 24 h, and the control group (n = 43) comprised children who had not received phototherapy. Ophthalmic examinations consisted of assessment of visual acuity, convergence near point, ocular movements, ocular alignment, dynamic retinoscopy, cycloplegic refraction and biomicroscopic examination of anterior segment and posterior segment (using a 90 D lens in the latest). ResultsAll children were orthophoric and had normal eye movements. A significant difference was found between the phototherapy group and control group regarding convergence near point 3.0 (2.0–5.0) vs 3.0 (2.0–5.0) (p = 0.018), right cycloplegic spherical equivalent 1.0 (0.0–3.0) vs 0.75 (0.0–4.75) (p = 0.011) and left cycloplegic spherical equivalent 1.0 (0.075–3.0) vs 0.75 (0.0–5.25) (p = 0.006).The study groups were similar according to cycloplegic spherical and cylindrical refractions. However, no significant difference was found between the groups regarding the need for eye glasses. ConclusionAlthough there were significant differences between the phototherapy and the control groups according to the convergence near point and right and the left eye cycloplegic spherical equivalent, the similarity between the groups regarding the need for eyeglasses suggested that difference was clinically insignificant.

Treatment Effect of Probiotic Bacillus Clausii on Neonatal Jaundice in Late Preterm and Term Newborn Babies: An Experimental Study

Objective: To evaluate the effect of prophylactic probiotic Bacillus clausii treatment on the need and duration of phototherapy in new born babies. Design: Open labeled clinical trial. Setting: Level II obstetric ward of a teaching hospital in Southern India. Participants: A total of 1043 babies with a gestational age of more than 35 weeks were enrolled in the study. There were 510 babies in the probiotic Bacillus clausii intervention group and 533 babies in the control group. Intervention: Intervention group babies 37 weeks) twice a day for 3 days. Main outcome measure: The outcome measures were (i) Need of phototherapy and (ii) Duration of phototherapy. Results: A total of 32 babies in control group and 17 in intervention group required phototherapy. This difference in need for phototherapy was statistically significant between the two groups (p 0.04). Treatment with probiotic reduced the risk of need for phototherapy by 44% (RR 0.56, 95% CI 0.32, 0.99).The median duration of phototherapy in the intervention group was 18 hrs( IQR 16.50, 24.00) and that of control group was 24 hrs (IQR 18.00, 48.00). This difference in duration of phototherapy was statistically significant (p=0.027). No adverse drug reactions were noticed in the intervention group. What is already known: The management of neonatal jaundice depends on phototherapy and exchange transfusion. What this study adds: Prophylactic probiotic therapy appears to reduce the need and duration of phototherapy in neonatal jaundice. Conclusion: Prophylactic treatment of probiotic Bacillus clausii for three consecutive days reduced both the need as well as the duration of phototherapy in newborn babies.

Therapeutic difference in some treatment modalities of jaundice in Egyptian neonates

Background: Jaundice is a significant problem in the early neonatal period due to excessive destruction of red blood cells or immature liver enzymes detoxifying bilirubin which may lead to neurotoxicity and brain damage in severe cases. Patients and Methods: A prospective clinical trial study was conducted on 120 neonates in neonatal Intensive Care Unit at Tanta University Hospital from May 2014 to August 2015. All of them suffering from neonatal jaundice. All of them received phototherapy, sixty of them (Group I) received phenobarbitone, and sixty of them (Group II) received fenofibrate. Results: There was no statistically significant difference between the two studied groups as regard total serum bilirubin (TSB) at time of admission (peak of TSB) P = 0.8, while there was a high statistical significant difference between both groups as regard TSB after 24 h P = 0.000, TSB after 48 h P = 0.000, and TSB at time of discharge (TSBD) P = 0.000, mean of TSB at time of admission is 17.9 ± 2.2 mg/dl in Group I and 18 ± 2.3 mg/dl in Group II, mean of TSB after 24 h is 16.3 ± 0.9 mg/dl in Group I and 11.5 ± 2.4 mg/dl in Group II, mean of TSB after 48 h is 12.8 ± 3 mg/dl in Group I and 6.7 ± 1.7 mg/dl in Group II, and finally mean of TSBD is 9.2 ± 0.6 mg/dl in Group I and 6.5 ± 1.4 md/dl in Group II. Conclusion: We concluded that oral fenofibrate in a dose of (10 mg/kg single dose) with phototherapy is more effective than oral phenobarbitone in a dose of (3 mg/kg/day for 3 days) with phototherapy in neonatal jaundice, so oral fenofibrate in this dose-treated neonatal jaundice more effective than oral phenobarbitone with avoidance of most of its side effects.

Declining pattern of bilirubin in the first and second six hours of intensive versus double phototherapy in neonatal jaundice

Declining pattern of bilirubin in the first and second six hours of intensive versus double phototherapy in neonatal jaundice

Soluble CD14 subtype (sCD14-ST) presepsin in premature and full term critically ill newborns with sepsis and SIRS

Neonatal sepsis still remains a major cause of morbidity and mortality in neonatal intensive care unit (NICU). Recently, soluble CD14 subtype (sDC14-ST) also named presepsin, was proposed as an effective biomarker for diagnosing, monitoring, and assessing the risk of neonatal sepsis and septic shock. The aim of this study was to investigate the diagnostic accuracy of sCD14-ST presepsin in diagnosing neonatal bacterial sepsis and in discriminating non-bacterial systemic inflammatory response syndrome (SIRS) from bacterial sepsis. This study involved 65 critically ill full-term and preterm newborns admitted to the neonatal intensive care unit (NICU), divided into three groups: 25 newborns with bacterial neonatal sepsis (group A); 15 newborns with a diagnosis of non-bacterial SIRS and with no localizing source of bacterial infection (group B); and 25 babies with no clinical or bacteriological signs of systemic or local infection receiving routine NICU care, most of them treated with phototherapy for neonatal jaundice (group C). A total of 102 whole blood samples were collected, 40 in group A, 30 in group B and 32 in group C. In 10 babies included in group A, sCD14-ST presepsin was also measured in an additional second blood sample collected 3days after the start of antibiotic treatment. sCD14-ST presepsin was measured by a commercially available chemiluminescent enzyme immunoassay (CLEIA) optimized on an automated immunoassay analyzer. Statistical analysis was performed by means of MedCalc® statistical package; receiver operating characteristic (ROC) analysis was computed, and the area under the ROC curve (AUC) was used to evaluate the ability of sCD14-ST to discriminate neonatal bacterial sepsis from non-bacterial SIRS. Blood sCD14-ST presepsin levels were found significantly higher in bacterial sepsis when compared with controls (p<0.0001); similarly, they were higher in non-bacterial SIRS when compared with controls (p<0.0001). However, no statistically significant difference was found between bacterial sepsis and non-bacterial SIRS (p=0.730). In our population, CRP and sCD14-ST did not correlate with each other. ROC analysis revealed that sCD14-ST presepsin has an area under the curve (AUC) of 0.995 (95% C.I.: 0.941–1.00) greater than that of CRP (0.827; 95% C.I.: 0.72–0.906). Similarly, in the group of babies with non-infectious SIRS, sCD14-ST AUC was greater than CRP AUC (0.979; 95% C.I.: 0.906–0.999 versus 0.771; 95% C.I.: 0.647–0.868). In controls, preliminary reference intervals for sCD14-ST ranged 223.4–599.7ng/L, being significantly different from those previously published elsewhere. In conclusion, sCD14-ST presepsin could be introduced in clinical practice as a diagnostic tool for improving the management of neonatal sepsis and non-bacterial SIRS.

Adherence to phototherapy guidelines in term neonates: Study at a private tertiary-level neonatal unit

Guidelines for starting phototherapy for neonatal jaundice in term neonates have been published by the American Academy of Pediatrics (AAP) and others, such as the National Institute for Health and Clinical Excellence (NICE), but the practical implementation of such guidelines and factors associated with possible non-adherence have not been studied. We report our experience at a self-paying tertiary-care hospital. Of the 155 term babies given phototherapy in our hospital between August 2012 and August 2013, 65 (41.9%) babies were found to have received phototherapy at serum bilirubin values lower than recommended AAP guidelines. Factors found responsible for non-adherence to guidelines were: ( i ) parents’ request for early discharge, with unwillingness to come the next day for follow-up despite borderline serum bilirubin level noted in 25 (38.5%); ( ii ) clinical assessment of bilirubin was higher than reported laboratory value in 16 (24.6%); and ( iii ) babies were given phototherapy as parents had been counselled regarding the need for phototherapy by a referring paediatrician in 12 (18.5%).