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Rebound in Serum Bilirubin Level Following Intensive Phototherapy
M. Jeffrey Maisels, MB, BCh;
Elizabeth Kring, RN
Arch Pediatr Adolesc Med. 2002;156:669-672.
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.
Design 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). All infants received intensive phototherapy but were managed
by individual attending pediatricians. Rebound measurements were included
if a bilirubin level was obtained between 4 and 48 hours after discontinuing
phototherapy.
Setting Newborn nursery and pediatric ward of a large community hospital.
Main Outcome Measures The number of infants who received repeated phototherapy and the magnitude
of the bilirubin-level rebound.
Results Thirteen (8.2%) of 158 (95% confidence interval [CI], 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 = .002). 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. 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).
Conclusions It is not necessary to keep infants in the hospital to check for rebound.
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. 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.
From the Department of Pediatrics, William Beaumont Hospital, Royal
Oak, Mich.
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