Since this type of phototherapy produces a more rapid decline in the TSB level than does conventional phototherapy, it is possible that a greater rebound might occur. Since 1995, we have used intensive phototherapy 6 to treat all infants with hyperbilirubinemia who require phototherapy. Infants who are discharged following birth and readmitted with hyperbilirubinemia have significantly higher total serum bilirubin (TSB) levels than those who are treated before they are discharged from the nursery. 4, 5 The infants in all of these studies were treated during their birth hospitalization (as opposed to having been readmitted for phototherapy). Examination of other published data suggests that significant rebound following discontinuation of phototherapy is rare. 2, 3 These studies included both term and preterm infants and concluded that the measurement of rebound bilirubin levels following phototherapy was probably unnecessary. Only 2 observational studies have specifically addressed this issue. 1 Nevertheless, many physicians keep infants in the hospital for several hours to obtain a rebound bilirubin level after phototherapy has been discontinued. 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.ĭECREASING hospital length of stay is an objective sought by physicians and administrators alike, and the American Academy of Pediatrics has recommended that infants need not be kept in the hospital to measure rebound bilirubin levels following the discontinuation of phototherapy. 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. 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 ( P<.001).Ĭonclusions It is not necessary to keep infants in the hospital to check for rebound. 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. Results Thirteen (8.2%) of 158 (95% confidence interval, 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 =. Main Outcome Measures The number of infants who received repeated phototherapy and the magnitude of the bilirubin-level rebound. Setting Newborn nursery and pediatric ward of a large community hospital. Rebound measurements were included if a bilirubin level was obtained between 4 and 48 hours after discontinuing phototherapy. All infants received intensive phototherapy but were managed by individual attending pediatricians. 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.ĭesign 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). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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