Unconjugated Hyperbilirubinemia Research Articles

An Evaluation of Infants Followed up With a Diagnosis of Indirect Hyperbilirubinemia

Amaç: İndirekt hiperbilirubinemi tanısıyla yatırılan yenidoğanların klinik ve demografik özellikleri, risk faktörleri ve tedavi yöntemlerinin araştırılması amaçlandı. Materyal ve Metod: Yenidoğan yoğun bakım ünitesine yatırılan 615 sarılıklı yenidoğan bebeğin demografik özellikleri, laboatuvar verileri ve yenidoğan sarılığı açısından risk faktörleri retrospektif olarak incelendi. Bulgular: Bebeklerin 340 (% 55,3)' ı kız, 275 (% 44, 7)' i erkek, 532 (% 86,50)' si matür, 80 (% 13)'i prematür ve 3 (% 0,50)'ü ise postmatür idi. Doğum ağırlıkları; 3185 gr ± 0, 50, 3200 (1300-5000) arasında idi. Olgularda en sık sarılık nedeni, Fizyolojik sarılık / Nedeni tespit edilemeyen sarılıklar iken, en az oranda tespit edilen sarılık nedeni ise intrakranial kanama ve konjenital santral sinir sistemi anomalileri idi. Tedavide, bebeklerin 406 (% 66,0)’sına sadece fototerapi, 35 (% 5,7)’ine ise kan değişimi de yapıldı. Diğer 174 olguya (% 28,3) fototerapi ile birlikte primer hastalığa bağlı olarak antibiyotik, sodium L-tiroksin ve/veya intravenöz sıvı tedavisi de verildi. Olguların 13 (% 2,1)'ünde rebound sarılık, 3 (% 0,5)'ünde geçici hipokalsemi, 1 (% 0,2)' inde anemi ve 1 (% 0,2)' inde ise ishal gelişti. 7 (% 1, 1) olgu altta yatan neden bağlı olarak ex oldu. 1 (% 0,2) bebekte kernikterus gelişirken, 607 (% 98,7) olgu şifa ile taburcu edildi. Sonuç: Hiperbilirubinemi, yenidoğan döneminde sık görülmektedir. Mortalite ve morbidite engellenmesinde hiperbilirubinemi tedavisinin zamanlaması son derece önemlidir.

Exploring a Case of Unconjugated Hyperbilirubinaemia Resulting from the Rare Coexistence of Inherited Disorders- A Case Report

Exploring a Case of Unconjugated Hyperbilirubinaemia Resulting from the Rare Coexistence of Inherited Disorders- A Case Report

Adrenal Hypoplasia Congenita Presenting as Adrenal Crisis, Unconjugated Hyperbilirubinemia, and Hyperpigmentation

Adrenal hypoplasia congenita is a relatively rare disorder characterized by atrophy or hypoplasia of the adrenal gland. It was first described by Sikl H in 1948 in 33-day-old infant. It is inherited as an autosomal recessive or X-linked disorder. It presents usually with adrenal insufficiency. In this article, we are presenting a case of congenital adrenal hypoplasia which presented with hypoglycemia, adrenal insufficiency, hyperbilirubinemia, and acquired hyperpigmentation in the neonatal period.

Mechanistic static modeling predicts low risk of unconjugated hyperbilirubinemia due to UGT1A1 inhibition by pirtobrutinib 200 mg once daily

Mechanistic static modeling predicts low risk of unconjugated hyperbilirubinemia due to UGT1A1 inhibition by pirtobrutinib 200 mg once daily

Forgoing Exchange Transfusion in Neonatal Hyperbilirubinemia: A Single-Center Retrospective Cohort Study.

Unconjugated hyperbilirubinemia is part of the everyday life of the neonatal period as it reflects the adaptation of the metabolism of bilirubin. The neonatal hyperbilirubinemia usually resolves spontaneously, but it can also be the cause of an acute or chronic encephalopathy known as kernicterus. Regardless of the cause, the goal of therapy is to prevent this neurotoxicity while not causing undue harm. Phototherapy and, if it is unsuccessful, exchange transfusion (ECT)remain the primary treatment modalities used to keep the maximal total serum bilirubin (TSB) below pathologic levels. This is a descriptive retrospective cohort study of 69 live neonates hospitalized in the Department of Neonatology and Neonatal Resuscitation of Mohammed VI University Hospital with unconjugated hyperbilirubinemia requiring ECT and treated with intensive phototherapy instead, spanning five years from March 2016 to March 2021. We aim to demonstrate the effectiveness of phototherapy in achieving prolonged reduction of bilirubin levels and the prevention of neurological complications and to compare our results with those in the literature. The use of intensive phototherapy in the treatment of neonatal unconjugated hyperbilirubinemia is very effective in lowering total serum bilirubin when its level is in the range of exchange transfusion, and it has succeeded in preventing the neurological complications of severe hyperbilirubinemia. Through this study, it can be seen that phototherapy is an efficacious, simpler, and less hazardous alternative to exchange transfusion in achieving a sustained reduction of bilirubin levels and preventing neurological complications.

Why Infants with Some Inherited Metabolic Diseases do not Develop Neonatal Indirect Hyperbilirubinemia ? An Overlooked Detail

Why Infants with Some Inherited Metabolic Diseases do not Develop Neonatal Indirect Hyperbilirubinemia ? An Overlooked Detail

Case Report: Intrahepatic cholestasis: a diagnostic dilemma

Cholestasis is an impairment of bile formation or bile flow. The mechanisms of cholestasis can be broadly classified into intrahepatic and extrahepatic. Most of the time, etiology can be determined with proper history, physical examination, and diagnostic testing including laboratory and imaging tests. This is a case report of a patient with severe cholestasis who underwent extensive evaluation to determine the etiology of intrahepatic cholestasis. This Case Report details a 28-year-old male who presented with seven days’ history of yellowish discoloration of eyes, the passage of dark-colored urine, generalized body itching, and the passage of clay-colored stool. The patient had no similar episode in the past. Laboratory investigations showed unconjugated hyperbilirubinemia and increased alkaline phosphatase. Magnetic resonance cholangiopancreaticography was unremarkable and liver biopsy was suggestive of cholestatic pattern and negative for acute hepatitis. The bilirubin level started decreasing after a month. The etiology of intrahepatic cholestasis remained unknown. Genotyping could not be done due to limited available resources. It may have helped to diagnose familial hepatocellular cholestasis such as benign recurrent intrahepatic cholestasis (BRIC) and progressive familial intrahepatic cholestasis. Gamma-glutamyl transferase is normal or mildly elevated in patients with BRIC. A similar picture was seen in our case as well. If the patient presents again with similar symptoms and findings, we can consider the diagnosis of BRIC.

Effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates: a randomised controlled trial

ABSTRACT Introduction Raised serum bilirubin levels can cause kernicterus, and premature infants are at increased risk owing to metabolic immaturity. The standard treatment for neonatal jaundice is phototherapy, but probiotics alone can reduce the duration of phototherapy and hospitalisation. Objectives To determine the effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates. Patients and methods The open-labelled randomised controlled trial was conducted from January 2022 to January 2023 in the neonatal unit of the University of Lahore Teaching Hospital, Pakistan. A total of 76 preterm neonates who fulfilled the selection criteria were included and divided into two groups. Both groups received standard phototherapy. In Group B, a probiotic (Saccharomyces boulardii) 125 mg, twice daily, orally (in 5 cc of whichever milk the infant was receiving) was given until discharge from hospital. The primary outcome measurements were the duration of phototherapy and the length of hospitalisation. Results The mean (SD) duration of phototherapy was 36.55 (14.25) hours in Group A and 24.61 (9.25) hours in Group B (p <0.05). The mean (SD) duration of hospital stay was 47.36 (16.51) hours in Group A and 33.13 (8.93) hours in Group B (p <0.05). Conclusion Oral probiotics (Saccharomyces boulardii) have a significant effect on the duration of phototherapy for neonatal hyperbilirubinaemia, and they decrease the chances of nosocomial infection. Exploration of clinical outcomes by investigating faecal flora and undertaking large randomised controlled trials of various probiotics are needed. Abbreviations ABE: acute bilirubin encephalopathy; CNS: central nervous system;GA: gestational age; IVIG: intravenous immunoglobulin; KSD: kernicterus;NNU: neonatal unit; RCT: randomised controlled trial; S. boulardii: Saccharomyces boulardii.

Glucose-6-phosphate dehydrogenase deficiency and neonatal indirect hyperbilirubinemia: a retrospective cohort study among 40,305 consecutively born babies.

Glucose-6-phosphate dehydrogenase deficiency (G6PDD) being highly prevalent in the Middle East, the primary objective was to estimate the incidence of neonatal jaundice among G6PD-deficient neonates and to explore its association with various risk factors. This retrospective cohort study includes 7 years data of neonates diagnosed with G6PDD between 1st January 2015, and 30 September 2022, from Al Wakra Hospital, HMC Qatar. Among the 40,305 total births, 1013 had G6PDD with an incidence of 2.51%. Of all the G6PDD babies, 24.6% (249/1013) received phototherapy and three babies required exchange transfusion. Statistically significant associations were noted between the need for phototherapy and gestational age, gestational age groups, birth weight, and birth weight groups, but logistic regression analysis showed significant association for phototherapy only with the gestational age group. Universal screening and proper follow-up is essential for G6PDD as it plays crucial role in neonatal jaundice.

Risk factors for exchange transfusion in neonates with unconjugated hyperbilirubinemia: A tertiary care hospital study.

Risk factors for exchange transfusion in neonates with unconjugated hyperbilirubinemia: A tertiary care hospital study.

The effect of kangaroo mother care of newborns with indirect hyperbilirubinemia on breastfeeding

BackgroundPhototherapy used in the treatment of hyperbilirubinemia may have a negative effect on breastfeeding. AimThe aim of the study was to assess the effect of kangaroo mother care (KMC) applied to newborns with indirect hyperbilirubinemia on breastfeeding. MethodsThis was a non-randomized experimental study with a control group. The study was conducted with 54 neonates (30 control group, 24 experimental group) who met the inclusion criteria. Under the researcher's supervision, the experimental group received KMC twice during hospitalization, with each session lasting for 1 h, during which phototherapy was temporarily interrupted. ResultsThe KMC group had a significantly higher number of breastfeeding episodes, pre-discharge LATCH score, defecation, and a significantly shorter duration of phototherapy compared to those in the control group (p < 0.05). ConclusionKMC applied to newborns with indirect hyperbilirubinemia was found to increase breastfeeding, the LATCH score, and defecations, and decrease the phototherapy duration.

Rare red cell enzymopathies in the indian population: A comprehensive review

Red blood cell enzyme deficiencies are a rare category of hemolytic anaemia presented in children with varying degrees of hemolysis, indirect hyperbilirubinemia and splenomegaly. Glucose 6-phosphate dehydrogenase deficiency is the most common enzyme deficiency, followed by pyruvate kinase deficiency. This article aims to understand the pathophysiology of the rare enzymopathies due to deficiencies in the Embden-Meyerhoff pathway, glutathione metabolism, hexose monophosphate shunt and Nucleotide metabolism pathway, and to study clinical symptoms, diagnostic strategy, management and incidence of enzyme deficiencies in Indian patients. Most RBC enzyme deficiencies are inherited in an autosomal recessive fashion except for glucose 6- phosphate dehydrogenase, and phosphoglycerate kinase deficiency which has X-linked inheritance. Presentation depends on the representation of the enzyme on different tissues of the body, hence some enzyme deficiencies may present with neurological or muscular manifestations. In patients with suspected hemolytic anaemia, complete blood count and peripheral smear help in differentiating from hemoglobinopathies etc. To clinch the diagnosis enzyme levels and genetic testing may be required. These tests are important to guide antenatal diagnosis in subsequent pregnancies. Management of RBC enzymopathies will depend on the predominant symptoms and severity of hemolysis. Patients with marked hemolysis require regular blood transfusions and hence appropriate chelation therapy. Hematopoeitic stem cell transplant is attempted in patients with severe spectrum with variable results. Newer drugs like Mitapivat have proven to be beneficial in adults with PK deficiency and ongoing trials in children are showing promising results.

Should We Consider UGT1A1 Mutation Analysis in Evaluating the Prolonged Jaundice of Newborn Infants?

Purpose: Uridine diphosphate glucuronosyltransferase 1A isoform 1 (&lt;i&gt;UGT1A1&lt;/i&gt;) is a crucial enzyme in bilirubin metabolism. Mutations in this gene cause prolonged unconjugated hyperbilirubinemia in infants. This study aimed to investigate the prevalence of &lt;i&gt;UGT1A1&lt;/i&gt; mutations and their association with prolonged, unexplained, and unconjugated hyperbilirubinemia in infants.Methods: From July 2019 to March 2023, 74 infants with prolonged jaundice lasting &gt;21 days were enrolled in this study. Diagnostic evaluations, including &lt;i&gt;UGT1A1&lt;/i&gt; mutation analysis, were performed to identify the underlying causes of hyperbilirubinemia. This retrospective review evaluated the incidence and types of mutations in &lt;i&gt;UGT1A1&lt;/i&gt;. The clinical and laboratory findings were compared based on the specific mutations detected.Results: Thirty-three infants agreed to &lt;i&gt;UGT1A1&lt;/i&gt; mutation analysis, and 30 (90.9%) were positive for &lt;i&gt;UGT1A1&lt;/i&gt; mutations. Single-nucleotide variants were detected in 20 (66. %) infants. The remaining 10 (33.3%) infants had multiple variants. No significant demographic differences were observed between the group that underwent &lt;i&gt;UGT1A1&lt;/i&gt; mutation analysis and the group that did not. Among the identified genetic variants, c.211G&gt;A (46.5%) and c.-3275T&gt;G (30.2%) were the two most common variants. The other variants had the following percentages: c.1456T&gt;G, c.-64G&gt;C, and c.1091C&gt;T (4.7% each); and c.-3152G&gt;A, c.189C&gt;T, and c.-41.-40 dup (2.3% each). Among the 20 infants with the c.211G&gt;A variant, eight (40.0%) had a homozygous genotype and 12 (60.0%) had a heterozygous genotype. Infants harboring other variants exhibited heterozygous genotypes. When comparing the group with confirmed &lt;i&gt;UGT1A1&lt;/i&gt; mutations to the group without detected mutations, breastfeeding was the only significant factor (&lt;i&gt;p&lt;/i&gt;=0.027). No significant differences were found between the group with singlenucleotide variants and the group with multiple genetic variants or between the homozygous genotype group with c.211G&gt;A and the heterozygous genotype group.Conclusion: Neonates with prolonged unconjugated hyperbilirubinemia may have a higher chance of &lt;i&gt;UGT1A1&lt;/i&gt; mutation than expected. Analysis of &lt;i&gt;UGT1A1&lt;/i&gt; mutations may be beneficial in infants with prolonged unexplained jaundice.

Gilbert syndrome in patients with inherited hemolytic anemia modifies the clinical phenotype

Gilbert syndrome is a benign condition due to UGT1A1 mutations frequently resulting in mild, indirect hyperbilirubinemia. Inherited hemolytic anemias often present with hyperbilirubinemia and hepatosplenomegaly. Over the years, there have been multiple case reports/series in which the extent of unconjugated hyperbilirubinemia exceeds the extent of anemia. When worked up for the unexplained hyperbilirubinemia, these patients were found to carry mutations corresponding to both immune hemolytic anemia as well as Gilbert syndrome. This article aims to emphasise when to suspect this coexistence and how to approach a patient with inherited hemolytic anemia with unexplained jaundice.

A rare presentation of severe alloimmune hemolytic disease of newborn pertaining to minor blood group ‘c’ incompatibility: a case report and review of literature

Hyperbilirubinemia is one of the most widely seen causes of neonatal morbidity. Haemolytic disease of fetus and newborn is caused by maternal alloantibodies to the fetal RBCs. It is responsible for incompatibility between maternal and fetal blood groups, which results in destruction of fetal red blood cells causing hyperbilirubinemia. ABO and Rh incompatibility are the most common causes of severe indirect hyperbilirubinemia. Besides ABO and Rh isoimmunization, minor blood group incompatibilities such as anti-Kell, anti-C, anti-c, anti-E, anti MNS, Duffy, KIDD, P, Lutheran and Lewis have also been identified as causes of severe neonatal jaundice with an incidence of 385/1,00,000 live births in South-East Asia. We, hereby report a rare case of a full term 2.2 kg newborn presented with severe anemia with reticulocytosis and neonatal hyperbilirubinemia at second hour of life. In view of strongly positive DCT and no Rh negative or ABO setting, minor blood group incompatibility screening test was performed in the mother which revealed presence of multiple alloantibodies; however, the red cell phenotyping confirmed the presence of anti-c antibodies in maternal sera responsible for neonatal alloimmune haemolytic anemia. The baby was offered intensive phototherapy with intravenous immunoglobulin.

UGT1A1 gene mutation spectrum with indirect hyperbilirubinemia in children

Objective: To explore the relevancy between the uridine diphosphate-glucuronylgly-cosyltransferase 1A1 (UGT1A1) gene mutation and the phenotype of indirect hyperbilirubinemia in children. Methods: Sixteen cases with indirect hyperbilirubinemia who visited the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from July 2013 to November 2019 were retrospectively analyzed and were divided into Gilbert syndrome (GS), Crigler-Najjar syndrome type II (CNS-II), and indirect hyperbilirubinemia groups unexplained by UGT1A1 gene mutations. The differences in gene mutation site information and general clinical data were compared. The association between gene mutation spectrum and bilirubin level was explored by t-test analysis. Results: Ten of the sixteen cases with indirect hyperbilirubinemia had GS, three had CNS-II, and three had indirect hyperbilirubinemia unexplained by UGT1A1 gene mutations. A total of six mutation types were detected, of which c.211G > A accounted for 37.5% (6/16), c.1456T > G accounted for 62.5% (10/16), and TATA accounted for 37.5% (6/16), respectively. Compared with the GS group, the CNS group had early disease onset incidence, high serum total bilirubin (t = 5.539, P < 0.05), and indirect bilirubin (t = 5.312, P < 0.05). However, there was no significant difference in direct bilirubin levels (t = 1.223, P > 0.05) and age of onset (t = 0.3611, P > 0.05) between the two groups. There was no significant correlation between the number of UGT1A1 gene mutations and serum bilirubin levels. Children with c.1456T > G homozygous mutations had the highest serum bilirubin levels. Conclusion: The common pathogenic variants of the UGT1A1 gene sequence are c.1456T > G, c.211G > A, and TATA, indicating that these site mutations are related to the occurrence of indirect hyperbilirubinemia and have important guiding significance for the etiological analysis of indirect hyperbilirubinemia in children.

Frequency of Urinary Tract Infection among Neonates with Persistent Jaundice at Lady Reading Hospital, Peshawar

Jaundice refers to yellow-orange discoloration of the skin and sclera, resulting from an excessive accumulation of bilirubin in the dermis and mucous membranes. Indirect neonatal hyperbilirubinemia is a prevalent and frequent etiology of jaundice, leading to the hospitalization of neonates in healthcare institutions worldwide. Objective: To determine the frequency of urinary tract infection among neonates with prolonged jaundice. Methods: The present study, a cross-sectional design, was carried out at the Department of Pediatrics, Lady Reading Hospital, Peshawar, from June 20th to December 20th, 2022. The study consisted of 87 infants, encompassing both genders, who presented with persistent jaundice. Two samples of clean urine were collected from neonates, with a time interval of many minimums of two hours between each collection. These samples were then sent to the hospital laboratory for diagnosing urinary tract infection. Results: The age range of participant neonates in this study ranged from 14 to 28 days, with a mean age of 20.597±4.50 days. The mean duration of complaint was also 18.20±4.077 days, and the mean weight was 2.855±0.27 Kg. The proportion of male patients was 58.6%, while the proportion of female patients was 41.4%. Among these 11.5% were found to have urinary tract infection. Conclusions: It is concluded that significant number (11.5%) of patients with persistent jaundice has urinary tract infection. It is likely a potential etiological factor contributing to neonatal unexplained prolonged indirect hyperbilirubinemia.

Clinical and genetic risk factors associated with neonatal severe hyperbilirubinemia: a case-control study based on the China Neonatal Genomes Project.

Objective: We aimed to investigate the clinical and genetic risk factors associated with neonatal severe unconjugated hyperbilirubinemia. Methods: This was a retrospective, 1:1 matched, case-control study. We included 614 neonates diagnosed with severe unconjugated hyperbilirubinemia (serum total bilirubin level ≥425μmol/L or serum total bilirubin concentration that met exchange transfusion criteria) from the China Neonatal Genomes Project in Children's Hospital of Fudan University. Clinical exome sequencing data were analyzed using a data analysis pipeline of Children's Hospital of Fudan University. The factors associated with severe unconjugated hyperbilirubinemia were assessed using univariable and multivariable logistic regression analyses. Interaction analyses were examined between clinical and genetic risk factors. Results: ABO/Rh incompatibility hemolysis (odds ratio [OR] 3.36, 95% confidence interval [CI] 2.32-4.86), extravascular hemorrhage (OR 2.95, 95% CI 2.24-3.89), weight loss (OR 5.46, 95% CI 2.88-10.36), exclusive breastmilk feeding (OR 3.56, 95% CI 2.71-4.68), and the homozygous mutant of UGT1A1 211G>A (OR 2.35, 95% CI 1.54-3.59) were all identified as factors significantly associated with severe unconjugated hyperbilirubinemia. The presence of UGT1A1 211G>A mildly increased the risk of severe unconjugated hyperbilirubinemia caused by ABO/Rh incompatibility hemolysis (OR 3.98, 95% CI 2.19-7.23), although the effect is not statistically significant. Conclusion: ABO/Rh incompatibility hemolysis, extravascular hemorrhage, weight loss, exclusive breastmilk feeding, and the homozygous mutant of UGT1A1 211G>A were found to be risk factors for severe unconjugated hyperbilirubinemia. Clinical factors remain the most crucial and preventable determinants in managing severe unconjugated hyperbilirubinemia, with a minimal genetic contribution. The establishment of preconception care practices and the reinforcement of screening for the aforementioned risk factors are essential steps for preventing severe unconjugated hyperbilirubinemia.

Comprehensive analysis of jaundice in pregnancy: Evaluating maternal and fetal outcomes – A 3-year retrospective study in a tertiary care center

Background: Jaundice during pregnancy poses significant risks to both maternal and fetal health. This retrospective study aimed to assess the incidence, causes, and outcomes of jaundice among pregnant women admitted to a tertiary care center over a 3-year period. Aims and Objectives: The primary objectives were to identify the incidence of jaundice, analyze its causes, and evaluate the maternal and fetal outcomes in cases of jaundice during pregnancy. Materials and Methods: Conducted as a case series with clinical correlation, the study spanned 3 years (2021–2023) at the Department of Obstetrics and Gynecology, Kempegowda Institute of Medical Science, Bangalore. Data from parturition books and case sheets were collected after institutional ethical committee approval. Investigations included a complete blood count, liver function tests, coagulation profile, and serology. Fetal and maternal outcomes were recorded. Results: Out of 9 cases, 7 were diagnosed with intrahepatic cholestasis of pregnancy (IHCP), while 1 case each involved hemolysis, elevated liver enzymes, low platelet syndrome, and unconjugated hyperbilirubinemia specific to pregnancy. IHCP is correlated with adverse perinatal outcomes, including meconium-stained amniotic fluid and fetal distress. Cesarean sections were prevalent (58%), often indicated by previous lower segment cesarean sections and non-progression of labor. Conclusion: The study underscores the substantial association between IHCP and adverse perinatal outcomes, emphasizing the heightened prevalence of cesarean sections in pregnancies complicated by jaundice. It highlights the necessity for vigilant monitoring and tailored management strategies to mitigate risks and ensure favorable maternal and fetal outcomes in cases of jaundice during pregnancy.

Single surface phototherapy with reflecting curtains versus double surface phototherapy in unconjugated neonatal hyperbilirubinemia in a tertiary care NICU

BACKGROUND Neonatal hyperbilirubinemia is treated with different modalities like single, double surface phototherapy and biliblankets. Reflecting curtains with single surface phototherapy is a cheaper and easy modality . So, this study was designed to compare the efficacy of single surface phototherapy with reflecting curtains [SSPRC] versus double surface phototherapy [DSP]. METHODS A prospective comparative study in 120 term neonates with unconjugated hyperbilirubinemia was conducted from July 2021 – Jan 2022 in Neonatal intensive care unit of College of Medical Sciences, Bharatpur. The study population was randomized to either SSPRC or DSP. The primary outcome was mean decrease and rate of decrease of bilirubin in subsequent 6 and 12 hours. Secondary outcome were duration of phototherapy and complications. The analysis was done using SPSS version 18.0. RESULTS Mean bilirubin level at 6 hours after starting phototherapy was 16.27 mg/dL vs 16.71 mg/dL, p=0.542 and at 12 hours 14.61 mg/dLvs 14.70 mg/dL, p= 0.428. Mean rate of decrease in SSPRC vs DSP was 1.63 mg/dL vs 1.81 mg/dL, p=0.154 at 6 hours, 3.29 mg/dL vs 3.82 mg/dL, p=0.39 at 12 hours. Mean duration of phototherapy was significantly lower in SSPRC 3.8 Vs 4.2 days, p=0.031.Complications were skin rashes 11.7% vs 16.7%, p=0.432 and change in frequency of stool 10.0% vs 8.3%, p=0.752. CONCLUSION Single surface phototherapy with reflecting curtain as double surface phototherapy is equally effective, reliable and successful in decreasing bilirubin in less duration with minimum complications. Therefore this technique can be of help where DSP is unavailable or unaffordable.