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(Pediatrics in Review Neo Reviews. 2000;1:e19-e24.)
© 2000 American Academy of Pediatrics

Recent Developments in the Management of Neonatal Hyperbilirubinemia

^*

^* Department of Neonatology, Shaare Zedek Medical Center; Faculty of Medicine of the Hebrew University, Jerusalem, Israel.

OBJECTIVES

After completing this article, readers should be able to:

1. Describe the morbidity associated with exchange transfusion used to treat neonatal hyperbilirubinemia.
   
2. Explain how phototherapy affects bilirubin.
   
3. Describe potential toxicities of phototherapy.
   
4. Explain the role of carboxyhemoglobin in hemolysis.
   
5. Delineate the guidelines for administering intravenous immunoglobulin to healthy ABO-incompatible Coombs-positive neonates.
   
6. Describe the action of protoporphyrins on bilirubin.
   

Introduction

Recent clinical trends toward early discharge coupled with a new, more relaxed, "kinder, gentler approach" to the treatment of newborn hyperbilirubinemia have thrust concerns about bilirubin-related toxicity once again to the forefront of neonatologists’ consciousness. In recent years we even have witnessed a resurgence of kernicterus, which had been rendered almost nonexistent in the 1970s and 1980s. Although exchange transfusion is the oldest and most effective method of treating hyperbilirubinemia, mortality associated with this therapy has been reported to be between 0.3% and 1.2% in healthy infants and as high as 10% to 25% in sicker preterm infants. Furthermore, potential morbidity related to exchange transfusion remains significant and includes anemia, apnea, bradycardia, hypothermia, sepsis, necrotizing enterocolitis, thromboembolic phenomena, graft versus host disease, transient metabolic abnormalities, and thrombocytopenia. Accordingly, it behooves us to re-evaluate other therapeutic modalities for hyperbilirubinemia that may be equally efficacious but less invasive.

Shedding New Light on Photototherapy

Ever since the 1950s, when Sister Ward of Rochford General Hospital in Essex noted that a jaundiced baby’s skin had "faded" in natural sunlight, physicians have been searching for artificial light sources that might be used safely to treat neonatal hyperbilirubinemia. Phototherapy, which has become the standard of care, has had such a dramatic impact that a recent editorial raised the concern that exchange transfusions are becoming extinct and lamented the fact that future generations of house officers may not receive adequate training in this procedure.

Under the effects of phototherapy light with maximal irradiance in the . . . [Full Text of this Article]

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				L. Davidson and E. H. Thilo How to Make Kernicterus a "Never Event" NeoReviews, November 1, 2003; 4(11): e308 - 314. [Full Text] [PDF]