Short-time intensive phototherapy of hyperbilirubinemic neonates: efficacy, bilirubin rebound and risk factors for rebound.

Abstract

Aim: To determine efficacy, frequency of bilirubin rebound, and risk factors for rebound for late preterm or term neonates with hyperbilirubinemia receiving short intensive phototherapy. This is a prospective clinical single-arm quality assurance study. The neonates received 12 h intensive, double phototherapy (65 + 39 µW/cm²/nm), using blue LED light. The bilirubin rebound frequency, investigated 24-48 h post-treatment, was compared with the frequencies in conventional overhead treatment lasting 24 h, using data from two previously published studies. In total, 103 neonates were included in the study. The efficacy expressed by the decrease in total serum bilirubin (TSB) was 36%, and 14 (13.6%) of the 103 neonates developed rebound. The risk of rebound increased with decreasing gestational- and postnatal age, also difference between TSB at cessation of therapy and phototherapy threshold. Maturity was predominant. Mixed feeding was associated with increasing rebound frequency. The rebound frequencies in the previous studies were 14.3% and 16.7%, respectively. These frequences were not significantly different from the present rebound frequency. Short, intensive double phototherapy was efficient and rebound hyperbilirubinemia did not seem to increase compared to conventional overhead treatments. Shorter treatment reduces parent-neonate separation, which may benefit parent-neonate bonding and breastfeeding. The predominant risk factors of bilirubin rebound after phototherapy (12 h) were gestational age and postnatal age, expressing the maturity. When planning post-phototherapy follow-up, risk factors should be considered, especially the maturity. Neonates with gestational age <37 weeks and postnatal age ≤72 h should routinely receive 24 h treatment. The rebound frequency did not seem to increase compared to conventional single-directed treatments.