FPIN's Clinical Inquiries
Rebound Bilirubin Levels after Phototherapy in Neonates with Hyperbilirubinemia
Am Fam Physician. 2020 Nov 1;102(9):online.
In term newborns with hyperbilirubinemia treated with phototherapy, how often does obtaining a rebound bilirubin level four to six hours after discontinuation of phototherapy result in restarting phototherapy?
Rebound elevation of bilirubin levels after phototherapy discontinuation in healthy term neonates is infrequent (fewer than 2% of infants with levels less than 14 mg per dL [239 mmol per L] at initial discontinuation). Obtaining a repeat bilirubin level four to six hours after phototherapy discontinuation is not recommended. Repeat testing does not decrease rates of restarting phototherapy, adds expense, and prolongs hospitalizations. (Strength of Recommendation [SOR]: B, based on a retrospective cohort study, three retrospective chart reviews, and a clinical guideline.)
A repeat total serum bilirubin level should be obtained within 24 hours after discontinuing phototherapy in neonates with known hemolytic disease (positive Coombs test result) because significant rebound has been reported in these patients. (SOR: B, based on two retrospective studies and a clinical guideline.) Neonates with significant risk factors for hyperbilirubinemia (e.g., prematurity, low birth weight) are at higher risk of rebound hyperbilirubinemia, and rebound levels should be considered. (SOR: C, based on two retrospective studies.)
A 2015 retrospective cohort study of 226 neonates who received phototherapy for hyperbilirubinemia found that those who underwent repeat bilirubin measurement were not readmitted more often than those who were not retested (P = .98).1 Infants who were retested had significantly longer hospital stays (27.7 vs. 23.2 hours; P = .001). Five of 130 infants from the rebound testing group and four of 96 infants from the non–rebound testing group were readmitted for phototherapy. Those with bilirubin levels less than 14 mg per dL at the time of phototherapy discontinuation were unlikely to require repeat photo
Referencesshow all references
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3. Yetman RJ, Parks DK, Huseby V, et al. Rebound bilirubin levels in infants receiving phototherapy. J Pediatr. 1998;133(5):705–707.
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5. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia.. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004;114(4):1138]. Pediatrics. 2004;114(1):297–316.
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