FPIN's Clinical Inquiries

Rebound Bilirubin Levels after Phototherapy in Neonates with Hyperbilirubinemia


Am Fam Physician. 2020 Nov 1;102(9):online.

Clinical Question

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?

Evidence-Based Answer

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.)

Evidence Summary

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

Address correspondence to Paul Gordon, MD, at pgordon@medadmin.arizona.edu. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.


show all references

1. Berkwitt A, Osborn R, Grossman M. The utility of inpatient rebound bilirubin levels in infants readmitted after birth hospitalization for hyperbilirubinemia. Hosp Pediatr. 2015;5(2):74–78....

2. Al-Saedi SA. Rebound hyperbilirubinemia in term infants after phototherapy. Saudi Med J. 2002;23(11):1394–1397.

3. Yetman RJ, Parks DK, Huseby V, et al. Rebound bilirubin levels in infants receiving phototherapy. J Pediatr. 1998;133(5):705–707.

4. Maisels MJ, Kring E. Rebound in serum bilirubin level following intensive phototherapy. Arch Pediatr Adolesc Med. 2002;156(7):669–672.

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.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin



Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

More in Pubmed


Oct 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article