Phototherapy and Exchange Transfusion in Neonatal Hyperbilirubinaemia

In unconjugated hyperbilirubinemia, the ultimate goal is the prevention of kernicterus and its potentially devastating effects.

Phototherapy represented an important advance inthe treatment of jaundice, enabling the effective and relatively rapid reduction of high bilirubin levels and facilitating the prevention of kernicterus.

Exchange transfusion is the only alternative to phototherapy for controlling hyperbilirubinaemia.

American Academy of Pediatrics recommendations for phototherapy

Risk category Total serum bilirubin (mg/dL)
Age (h)
24 36 48 72 96
High risk (35–37 weeks + risk factorsa) 8 9 11 13 14
Medium risk (>/=38 weeks + risk factors or 35–37
weeks and well)
10 12 13 15 17
Low risk (>38 weeks and well) 12 13 15 18 20

a Risk factors are defined as isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis.

American Academy of Pediatrics recommendations for exchange transfusion

Risk category Total serum bilirubin (mg/dL)
Age (h)
24 36 48 72 96
High risk (35–37 weeks + risk factorsa) 15 16 17 18 19
Medium risk (>/=38 weeks + risk factors or 35–37
weeks and well)
16.5 18 19 20 22
Low risk (>38 weeks and well) 19 21 22 24 25

a Risk factors are defined as isoimmune hemolytic disease, G6PD deficiency, asphyxia, significant lethargy, temperature instability, sepsis, acidosis.

 

 

References:

  1. Rennie JM, Sehgal A, De A, Kendall GS, Cole TJ. Range of UK practice regarding thresholds for phototherapy and exchange transfusion in neonatal hyperbilirubinaemia. Arch Dis Child Fetal Neonatal Ed. 2009 Sep;94(5):F323-7. [Medline]
  2. Colletti JE, Kothari S, Jackson DM, Kilgore KP, Barringer K. An emergency medicine approach to neonatal hyperbilirubinemia. Emerg Med Clin North Am. 2007 Nov;25(4):1117-35 [Medline]
  3. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004 Jul;114(1):297-316. [Medline]

Created: May 26, 2010

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