I’ve already explain about the type of jaundice in my previous posting. In this particular posting, I want to share a briefly explanation about the treatment options for jaundice therapy.

A. Phototherapy

Phototherapy involves exposure of the naked baby to blue, cool white or green light of wave length 450-460 nm. The light waves convert the bilirubin to water soluble nontoxic forms which are then easily excreted. Every attempt should be made to find out the cause of jaundice. The advantages of phototherapy are that it is noninvasive, effective, inexpensive and easy to use. Frequent feeding every 2 hourly and change of posture should be promoted in an infant receiving phototherapy. Eye shades should be fixed. External genitalia may be covered as long as the infant is receiving phototherapy. Additional oral intake of plain water or glucose water is neither recommended nor necessary. Remember that the baby will appear bleached when under phototherapy and hence clinical assessment of jaundice is not reliable. Serum bilirubin must be monitored. Continuous phototherapy is better than intermittent phototherapy.

There are several factors that affect the dose and efficacy of phototherapy:

  1. Spectrum of light emitted: Blue-green spectrum is most effective. At these wavelengths, light penetrates skin well and is absorbed maximally by bilirubin. Use special blue tubes or LED light source with output in blue-green spectrum for intensive phototherapy.
  2. Spectral irradiance (irradiance in certain wavelength band) delivered to surface of infant: If special blue fluorescent tubes are used, bring tubes as close to infant as possible to increase irradiance. Special blue tubes 10–15 cm above the infant will produce an irradiance of at least 35 μW/cm per nm.
  3. Spectral power (average spectral irradiance across surface area): For intensive phototherapy, expose maximum surface area of infant to phototherapy. Double surface phototherapy may be more effective than single surface phototherapy.
  4. Cause of jaundice: phototherapy is likely to be less effective if jaundice is due to hemolysis or if cholestasis is present. When hemolysis is present, phototherapy starts at lower Total Serum Bilirubin (TSB) levels. Use intensive phototherapy. Failure of phototherapy suggests that hemolysis is the cause of jaundice.
  5. TSB level at start of phototherapy: The higher the TSB, the more rapid the decline in TSB with phototherapy. Use intensive phototherapy for higher TSB levels. Anticipate a more rapid decrease in TSB when TSB >20 mg/dL (342 μmol/L).

As long as the baby receives phototherapy, maintaining adequate hydration and good urine output should help to improve the efficacy of phototherapy. Failure of phototherapy has been defined as an inability to observe a decline in bilirubin of 1-2 mg/dl after 4-6 hours and/ or to keep the bilirubin below the exchange transfusion level. Exchange transfusion is recommended if the TSB rises to these levels despite intensive phototherapy.

There is no standard for discontinuing phototherapy. For infants who are readmitted after their birth hospitalization (usually for TSB levels of 18 mg/dL or higher), phototherapy may be discontinued when the serum bilirubin level falls below 13 to 14 mg/dL. Discharge from the hospital need not be delayed to observe the infant for rebound. If phototherapy is used for infants with hemolytic diseases or is initiated early and discontinued before the infant is 3 to 4 days old, a follow-up bilirubin measurement within 24 hours after discharge is recommended. For infants who are readmitted with hyperbilirubinemia and then discharged, significant rebound is rare, but a repeat TSB measurement or clinical follow-up 24 hours after discharge is a clinical option.

Sunlight Exposure, although sunlight provides sufficient irradiance in the 425- to 475-nm band to provide phototherapy, the practical difficulties involved in safely exposing a naked newborn to the sun either inside or outside (and avoiding sunburn) preclude the use of sunlight as a reliable therapeutic tool, and it therefore is not recommended.

B. Exchange Transfusion

Rh isoimmunization: Blood used for exchange transfusion in neonates with Rh isoimmunization should always have Rh negative blood group. The best choice would be O (Rh) negative packed cells suspended in AB plasma. O (Rh) negative whole blood or cross-matched baby’s blood group (Rh negative) may also be used in an emergency.

ABO incompatibility: Only O group blood should be used for exchange transfusion in neonates with ABO incompatibility. The best choice would be O group (Rh compatible) packed cells suspended in AB plasma or O group whole blood (Rh compatible with baby). Other situations: Cross-matched with baby’s blood group.

C. Pharmacological Treatment

Phenobarbitone: It improves hepatic uptake, conjugation and excretion of bilirubin thus helps in lowering of bilirubin. However, its effect takes time. When used prophylactically in a dose of 5 mg/Kg for 3-5 days after birth, it has shown to effective in babies with hemolytic disease, extravasated blood and in preterms without any significant side effects.

Intravenous Immunoglobulins (IVIG): High dose intravenous g-globulin (IVIG) (0.5 to 1 gm/Kg) has been shown to reduce the need for exchange transfusions in Rh and ABO hemolytic disease.

Pharmacologic Therapy: There is now evidence that hyperbilirubinemia can be effectively prevented or treated with tin-mesoporphyrin, a drug that inhibits the production of heme oxygenase. Tin-mesoporphyrin is not approved by the US Food and Drug Administration. If approved, tin-mesoporphyrin could find immediate application in preventing the need for exchange transfusion in infants who are not responding to phototherapy.

Hopefully, this post will give you helpful information about the treatment of jaundice for newborn.




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