● Home phototherapy Phototherapy (cont'd) ● Should be used only in infants whose bilirubin levels are in “optional phototherapy” range ● Essential that TSB be monitored regularly References 1. Jaundice <strong>and</strong> hyperbilirubinemia in the newborn. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of pediatrics. 16th ed. Philadelphia: Saunders, 2000:511–28. 2. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term <strong>and</strong> near-term newborns. Pediatrics 1999; 103:6. 3. Burke BL, Robbins JM, Bird TM, et al. Trends in hospitalizations for neonatal jaundice <strong>and</strong> kernicterus in the United States, 1988-2005. Pediatrics 2009; 123:524. 4. Volpe, JJ. Neurology of the Newborn, 4th ed, WB Saunders, Philadelphia, 2001, p. 521. 5. US Preventive Services Task Force. Screening of infants for hyperbilirubinemia to prevent chronic bilirubin encephalopathy: recommendation statement. Pediatrics. 2009;124 (4):1172 –1177. 6. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Management of hyperbilirubinemia in the newborn infant ≥35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124 (4):1193 –1198 7. Ebbesen F, Rasmussen LM, Wimberley PD. A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit <strong>and</strong> the maternity ward. Acta Paediatr. 2002;91 (2):203 –211. 8. Maisels MJ, Kring E. Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of ≥35 weeks’ of gestation. Pediatrics. 2006;117 (4):1169 –1173. 9. Engle W, Jackson GC, Stehel EK, Sendelbach D, Manning MD. Evaluation of a transcutaneous jaundice meter following hospital discharge in term <strong>and</strong> near-term neonates. J Perinatol. 2005;25 (7):486 –490. 10. Maisels MJ, Kring E. Transcutaneous bilirubin level in the first 96 hours in a normal newborn population of 35 weeks’ gestation. Pediatrics 2006;117:1169 –73. 11. Slusher TM, Angyo IA, Bode-Thomas F, Akor F,Pam SD, Adetunji AA, et al. Transcutaneous bilirubin measurements <strong>and</strong> serum total bilirubin levels in indigenous African infants. Pediatrics 2004;113:1636–41. ● Complications Phototherapy (cont'd) ● Separation of mother <strong>and</strong> infant ● Bronze infant syndrome in babies with cholestatic jaundice j ● Rarely, purpura <strong>and</strong> bullous eruptions have been described in infants with severe cholestatic jaundice ● Severe blistering <strong>and</strong> photosensitivity during phototherapy have occurred in infants with congenital erythropoietic porphyria Discharge <strong>and</strong> follow-up ● http://www.aap.org/family/jaundicefaq.htm ● Follow up assessment should include: ● Weight <strong>and</strong> % change from birth ● Intake <strong>and</strong> voiding ● Assessment of jaundice – if there is ANY doubt, obtain TSB or TcB References (cont'd) 12. SN El-Beshbishi, KE Shattuck, AA Mohammad, JR Petersen. Hyperbilirubinemia <strong>and</strong> Transcutaneous Bilirubinometry. Clinical Chemistry 55:71280–1287 (2009). 13. Petersen JR, Okorodudu AO, Mohammad AA,Fern<strong>and</strong>o A, Shattuck KE. Association of transcutaneous bilirubin testing in hospital with decreased readmission rate for hyperbilirubinemia.Clin Chem 2005;51:540–4. 14. Stevenson DK, Wong RJ, Vreman HJ, McDonagh AF, Maisels MJ, Lightner DA. NICHD conference on kernicterus: research on prevention of bilirubin-induced brain injury <strong>and</strong> kernicterus: bench-to-bedside: diagnostic methods <strong>and</strong> prevention <strong>and</strong> treatment strategies. J Perinatol 2004;24:521–5. 15. Nichols JH, Christenson RH, Clarke W, Gronowski A, Hammett-Stabler CA, Jacobs E, et al. Executive summary. The National Academy of Clinical Biochemistry Laboratory <strong>Medicine</strong> Practice Guideline: evidence-based practice for point-of-care testing. Clin Chim Acta 2007;379:14–28. 16. Harbrecht BG, Rosengart MR, Bukauskas K, Zenati MS, Marsh JW Jr, Geller DA. Assessment of transcutaneous bilirubinometry in hospitalized adults. J Am Coll Surg 2008;206:1129 –36. 17. Maisels MJ, Ostrea EM Jr, Touch S, Clune SE, Cepeda E, Kring E, et al. Evaluation of a new transcutaneous bilirubinometer. Pediatrics 2004; 113:1628 –35. 18. Suresh GK, Clark RE. Cost-effectiveness of strategies that are intended to prevent kernicterus in newborn infants.Pediatrics. 2004;114(4):917–924 19. Maisels MJ. Transcutaneous bilirubinometry. NeoReviews 2006;7:e217–25. 20. Gonçalves A, Costa S, Lopes A, Rocha G, Guedes MB, Centeno MJ, Silva J, Silva MG, Severo M, Guimarães H. Prospective validation of a novel strategy for assessing risk of significant hyperbilirubinemia. Pediatrics. 2011 Jan;127(1):e126-31. 21. Garl<strong>and</strong> JS, Alex C, Deacon JS, Raab K. Treatment of infants with indirect hyperbilirubinemia. Readmission to birth hospital vs nonbirth hospital. Arch Pediatr Adolesc Med. 1994;148:1317–1321 8
22. Gottstein R, Cooke R. Systematic review of intravenous immunoglobulin in haemolytic disease of the newborn. Arch Dis Child Fetal Neonatal Ed. 2003;88:F6–F10. 23. Maisels MJ, Kring E. Bilirubin rebound following intensive phototherapy. Arch Pediatr Adolesc Med. 2002;156:669–672. 24. Yetman RJ, Parks DK, Huseby V, Mistry K, Garcia J. Rebound bilirubin levels in infants receiving phototherapy. J Pediatr. 1998;133:705–707. 25. Lazar L, Litwin A, Merlob P. Phototherapy for neonatal nonhemolytic hyperbilirubinemia. Analysis of rebound <strong>and</strong> indications for discontinuing therapy. Clin Pediatr (Phila). 1993;32:264–267 9
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