Background

Current Treatments

Hey, the goal is to remove bilirubin

Phototherapy

The baby may be placed under a lamp that emits light in the blue-green spectrum. The light changes the shape and structure of bilirubin molecules in such a way that they can be excreted in both the urine and stool. During treatment, the baby will wear only a diaper and protective eye patches. Light therapy may be supplemented with the use of a light-emitting pad or mattress.

10% of births are treated with phototherapy

Intravenous immunoglobulin (IVIg)

Jaundice may be related to blood type differences between mother and baby. This condition results in the baby carrying antibodies from the mother that contribute to the rapid breakdown of the baby's red blood cells. Intravenous transfusion of an immunoglobulin — a blood protein that can reduce levels of antibodies — may decrease jaundice and lessen the need for an exchange transfusion.

Exchange transfusion

Rarely, when severe jaundice doesn't respond to other treatments, a baby may need an exchange transfusion of blood. This involves repeatedly withdrawing small amounts of blood and replacing it with donor blood, thereby diluting the bilirubin and maternal antibodies — a procedure that's performed in a newborn intensive care unit.

AAP Hyperbilirubinemia Guideline

The focus of this guideline is to reduce the incidence of severe hyperbilirubinemia and bilirubin encephalopathy while minimizing the risks of unintended harm such as maternal anxiety, decreased breastfeeding, and unnecessary costs or treatment.

In every infant, we recommend that clinicians:

  • promote and support successful breastfeeding;
  • perform a systematic assessment before discharge for the risk of severe hyperbilirubinemia;
  • provide early and focused follow-up based on the risk assessment;
  • when indicated, treat newborns with phototherapy or exchange transfusion to prevent the development of severe hyperbilirubinemia and, possibly, bilirubin encephalopathy (kernicterus).
Read Full Guideline Here

AAP Phototherapy Guideline

In 2011, the AAP published guidelines from Vinod Bhutani and the AAP Committee on Fetus and Newborn: Phototherapy to Prevent Severe Neonatal Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation.

Standards for phototherapy devices were recommended as well as what type of phototherapy should be administered:

  • Light wavelength
  • Emission of light in the blue-to-green range that overlaps the in vivo plasma bilirubin absorption spectrum (∼460–490 nm)
  • LED lights are effective and have a longer lifetime (>20 000 hours) than conventional light sources, lower heat output, low infrared emission and no ultraviolet emission
  • Light irradiance/intensity
  • Light intensity or energy output is defined by irradiance and refers to the number of photons (spectral energy)delivered per unit area (cm2) of exposed skin. Phototherapy dose is a measure of irradiance delivered for a specific duration and adjusted to the exposed body surface area.
  • Irradiance is measured with a radiometer (W·cm−2) or spectroradiometer (μW·cm−2·nm−1) over a given wavelength band
  • Often, radiometers measure wavelengths that do not penetrate skin well or that are far from optimal for phototherapy and, therefore, may be of little value for predicting the clinical efficacy of phototherapy units.
  • No single method is in general use for measuring phototherapy dosages. Calibration methods, wavelength responses,and geometries of instruments are not standardized. Consequently, different radiometers may show different values for the same light source.
  • Illumination of maximal body surface
  • Circumferential phototherapy covers~80% of the body surface;  Ventral ordorsal covers ~35%
  • Do not refer to phototherapy as double, triple, etc. Combined devices can interfere with each other decreasing surface area (or irradiance). When using more than one device, must pay closer attention to interference
  • Keep equipment as small as possible, e.g., diapers, masks, electrodes
  • Combining several devices, such asfluorescent tubes with fiber-optic pads or LED mattresses placed below theinfant or bassinet will increase the surface area treated
Read Full Guideline Here

Treating Newborn Jaundice Video

This video details phototherapy as a treatment tool for jaundice. This video is from The Children, Young People and Families Directorate of Hunter New England Local Health District - Australia