Rebound bilirubin levels in infants receiving phototherapy

Yetman, Robert J.; Parks, Deborah; Huseby, Valerie; Mistry, Ketna; García, José Alfredo

doi:10.1016/s0022-3476(98)70117-9

Cited by 37 publications

(25 citation statements)

References 10 publications

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“…[3][4][5]7,8,13 AAP 2004 guidelines recommend a follow up bilirubin measurement after 24 hours of discharge, though discharge from hospital need not be delayed for the same. [7][8][9]11,12 In addition Bansal et al also proposed delay in discharge for this purpose if follow-up cannot be ensured as is felt during current study.…”

Section: Discussionmentioning

confidence: 99%

Post phototherapy bilirubin rebound: incidence and risk factors

Soni¹,

Kaushik²,

Kaushik³

et al. 2017

Int J Res Med Sci

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Background: Rebound hyperbilirubinemia may occur after cessation of phototherapy in new-borns in certain high-risk situations. However, data regarding the phenomenon of bilirubin rebound is lacking from India. Aim was to study the incidence and associated risk factors of post phototherapy rebound hyperbilirubinemia.Methods: The study subjects included all neonates (gestation >34 weeks) admitted to newborn unit who required phototherapy for hyperbilirubinemia. Unit protocol based on American academy of pediatrics (AAP) guidelines were used to start and stop phototherapy. Rebound bilirubin was measured 24±6 hours after stopping phototherapy. Significant bilirubin rebound (SBR) was defined as post phototherapy bilirubin level needing reinstitution of phototherapy. The risk factors associated with significant rebound were studied.Results: Out of total 509 neonates who received phototherapy due to hyperbilirubinemia, 63 (12%) had significant bilirubin rebound requiring reinstitution of phototherapy. There was significant risk for rebound in neonates who had prematurity (p <0.01), ABO (<0.001) and Rh incompatibility (p<0.005) with mother, G6PD deficiency (p < 0.001) and onset of hyperbilirubinemia less than 72 hours of postnatal age (p< 0.001). However, neonates with extravasations of blood, polycythaemia, sepsis, other causes of haemolysis and idiopathic group did not have significant risk of developing rebound.Conclusions: Post phototherapy bilirubin estimation and follow up should be ensured in high-risk neonates.

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Section: Discussionmentioning

confidence: 99%

Post phototherapy bilirubin rebound: incidence and risk factors

Soni¹,

Kaushik²,

Kaushik³

et al. 2017

Int J Res Med Sci

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“…There is currently a lack of robust data addressing the value of early (<12 hours) inpatient rebound bilirubin levels; much of the previous research used to create the AAP guideline focused on rebound bilirubin levels that were drawn, on average, ≥12 hours from the cessation of phototherapy. [2][3][4][5][6] Although recent research has focused on attempts to improve adherence to AAP guidelines, it is also necessary to provide stronger evidence evaluating the effects of early inpatient rebound bilirubin levels. 7 The present study assessed the clinical utility of rebound bilirubin levels for infants readmitted with hyperbilirubinemia after their birth hospitalization.…”

Section: The Utility Of Inpatient Rebound Bilirubin Levels In Infantsmentioning

confidence: 99%

The Utility of Inpatient Rebound Bilirubin Levels in Infants Readmitted After Birth Hospitalization for Hyperbilirubinemia

Berkwitt

Osborn

Grossman

2015

Hospital Pediatrics

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“…Only 2 observational studies have specifically addressed this issue. 2,3 These studies included both term and preterm infants and concluded that the measurement of rebound bilirubin levels following phototherapy was probably unnecessary. Examination of other published data suggests that significant rebound following discontinuation of phototherapy is rare.…”

Section: Arch Pediatr Adolescmentioning

confidence: 99%

Rebound in Serum Bilirubin Level Following Intensive Phototherapy

Maisels

Kring²

2002

Arch Pediatr Adolesc Med

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Objectives: To document the need for repeated phototherapy (as an index of significant rebound in serum bilirubin levels) following the discontinuation of intensive phototherapy and to compare the use of repeated phototherapy in infants who first received phototherapy during their birth hospitalization with the use of first-time phototherapy on readmission after infants were discharged from their birth hospitalization.Design: A retrospective review of the medical records of 303 term and near-term newborns treated between January 1996 and December 1998, who received phototherapy in our well-baby nursery during their birth hospitalization (group 1, n = 158) or who had been discharged from the nursery and were readmitted for phototherapy (group 2, n = 144). All infants received intensive phototherapy but were managed by individual attending pediatricians. Rebound measurements were included if a bilirubin level was obtained between 4 and 48 hours after discontinuing phototherapy.Setting: Newborn nursery and pediatric ward of a large community hospital. Main Outcome Measures:The number of infants who received repeated phototherapy and the magnitude of the bilirubin-level rebound.Results: Thirteen (8.2%) of 158 (95% confidence interval [CI], 3.9-12.4) infants treated with phototherapy before discharge from the nursery (group 1) and only 1 (0.7%) of 144 (95% CI, 0-2.0) infants who first received phototherapy on readmission (group 2) received repeated phototherapy (P = .002). Phototherapy was discontinued when mean±SD total serum bilirubin levels were, 10.4±1.8 mg/dL (178±31 µmol/L) in group 1 and 12.3 ± 1.3 mg/dL (210 ± 22 µmol/L) in group 2. The mean±SD increase in the total serum bilirubin levels following rebound was 1.3±2.0 mg/dL (22±34 µmol/L) in group 1 and 0.27±1.46 mg/dL (4.6±25 µmol/L) in group 2 (PϽ.001).Conclusions: It is not necessary to keep infants in the hospital to check for rebound. However, for infants who require phototherapy during their birth hospitalization and for those with significant hemolytic disease, we recommend obtaining a follow-up bilirubin level 24 hours after discharge. This is probably not necessary in those who are readmitted for phototherapy but, because rare instances of significant rebound have occurred in these infants, additional clinical follow-up is appropriate, particularly if phototherapy is discontinued at higher total serum bilirubin levels than used in this study.Arch Pediatr Adolesc Med. 2002;156:669-672

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Rebound bilirubin levels in infants receiving phototherapy

Cited by 37 publications

References 10 publications

Post phototherapy bilirubin rebound: incidence and risk factors

Post phototherapy bilirubin rebound: incidence and risk factors

The Utility of Inpatient Rebound Bilirubin Levels in Infants Readmitted After Birth Hospitalization for Hyperbilirubinemia

Rebound in Serum Bilirubin Level Following Intensive Phototherapy

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