Neonatal Jaundice - Associates in Newborn Medicine

neonatology
neonatal jaundice
Figure 3. The risk factors listed for this figure increase the likelihood of brain damage at different bilirubin concentrations. Infants
are designated as “higher risk” because of the potential negative effects of the conditions listed on albumin binding of bilirubin, the
blood-brain barrier, and the susceptibility of the brain cells to damage by bilirubin. “Intensive phototherapy” implies irradiance in
the blue-green spectrum (wavelengths of approximately 430 to 490 nm) of at least 30 mcW/cm 2 per nanometer (measured at the
infant’s skin directly below the center of the phototherapy unit) and delivered to as much of the infant’s surface area as possible.
Note that irradiance measured below the center of the light source is much greater than that measured at the periphery.
Measurements should be made with a radiometer specified by the manufacturer of the phototherapy system. If total serum bilirubin
values approach or exceed the exchange transfusion line, the sides of the bassinet, incubator, or warmer should be lined with
aluminum foil or white material to increase the surface area of the infant exposed and increase the efficacy of phototherapy. If the
total serum bilirubin value does not decrease or continues to rise in an infant who is receiving intensive phototherapy, this strongly
suggests the presence of hemolysis. Infants who receive phototherapy and have an elevated direct-reacting or conjugated bilirubin
level (cholestatic jaundice) may develop the bronze baby syndrome. Reprinted with permission from Maisels MJ, Baltz RD, Bhutani
V, et al. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316.
bilirubin concentration as soon as possible. Intensive
phototherapy implies the use of irradiance in the 430 to
490-nm band of at least 30 mcW/cm 2 per nanometer
delivered to as much of the infant’s surface area as possible
(Table 2-E in the online edition of this article).
Increasing the surface area exposed to phototherapy
improves the therapy’s efficacy significantly. This is accomplished
by placing fiberoptic pads or a light-emitting
diode (LED) mattress below the infant or using a phototherapy
device that delivers phototherapy from special
blue fluorescent tubes both above and below the infant.
When intensive phototherapy is applied appropriately, a
Pediatrics in Review Vol.27 No.12 December 2006 451
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