ACW Lee, WT Lung, R Li, H Ng, K Tse, NS Kwong

Abstract

In contrast to the initiation of treatment for neonatal jaundice, specific guidelines for discontinuation of phototherapy and subsequent management of the infants are lacking. The current study aims at documenting the current practice and examining if babies can be discharged from phototherapy without routine evaluation for rebound hyperbilirubinaemia. Between January and May 1998 inclusively, all neonates aged under two weeks with a birth weight >= 2,200 grams admitted for phototherapy were recruited for the study. Babies were excluded if they required intensive care, received parenteral nutrition, or were receiving antibiotics at the time of discontinuation of phototherapy. 154 infants were enrolled. Seven (4.5%) babies required a second course of phototherapy because their SB rebounded into the treatment range. When compared with those babies not requiring treatment again, they had a higher mean SB (234.3 vs 204.1, p<0.001) and were more likely to be younger than five days of life (3/7 vs 16/147, p=0.041) when phototherapy was first stopped. Other factors like sex, cephalhaematoma, glucose 6 phosphate dehydrogenase deficiency, blood groups, Coombs' test, onset of jaundice, and haemoglobin level were not found to be significant. If a threshold of SB <= 216 μmol/L (or 234 μmol/L less 2 standard deviations) were used for discontinuation of phototherapy without routine evaluation for rebound hyperbilirubinaemia, 61% of the "well" babies in this study would have had an earlier discharge. Thus, a more structured guideline on the management of discontinuation of phototherapy is indicated for evaluation of our current practice.