Rebound serum bilirubin levels after single vs. double phototherapy
Abstract
Background Hyperbilirubinemia is the most common clinical
phenomenon found in newborns. Phototherapy is the standard
treatment for lowering bilirubin levels in neonates. While
intensive (double) phototherapy produces a more rapid decline
in serum bilirubin levels than standard (single) phototherapy,
greater rebound effects may occur.
Objective To assess bilirubin levels in neonates with hyperbilirubinemia
who underwent single or double phototherapy, including
rebound bilirubin levels after phototherapy termination.
Methods An open, randomized, controlled trial was con ducted
at H. Adam Malik Hospital and Dr. Pirngadi Hospital, Medan,
from August 2009 until January 2010. Subjects with indirect
hyperbilirubinemia were divided into two groups. One group
received single phototherapy (n = 41) and other received
double photo therapy (n = 40) . Measurements of total plasma
bilirubin level were conducted at 12 hours and at 24 hours
of phototherapy, as well as at 24 hours after phot otherapy
termination. Rebound bilirubin serum level was defined as
an increment of about 1 - 2 mg/dL serum bilirubin after
phototherapy discontinuation.
Results The decreases in serum bilirubin levels were significantly
greater in the do uble phototherapy group for observations
at 12 h ours , 24 h ours, and 24 hours after phototherapy
t ermination (P = 0.0001). At the 24-hour observation after
terminationofphototherapy, only 1 neonate (2.7%) in the single
phototherapy group compared to 4 neonates (10.8%) in the
double phototherapy group had serum bilirubin level increases
of 1 - 2 mg/dL. Fisher's exact test did not reveal a significant
difference in rebound serum bilirubin occurrence in the two
groups (P = 0.358).
Conclusion Double phototherapy shows significantly greater
decrease in bilirubin level compared to single phototherapy
within a same period of time. Rebound serum bilirubin levels after
single and double phototherapy may occur in some patients with
hyperbilirubinemia, as bilirubin production continues. However,
260 • Paediatr Irulones, Vol. 54, No. 5, September 2014
there is no significant difference in rebound effects between single
vs. double phototherapy.
References
Wong RJ, Stevenson DK, Ahlfors CE, Vreman HJ. Neonatal jaundice: bilirubin physiology and clinical chemistry. NeoReviews. 2007;8:e58-67.
Sukadi A. Hiperbilirubinemia. In: Kosim MS, Yunanto A, Dewi R, Sarosa GI, Usman A, editors. Buku ajar neonatologi. 1st ed. Jakarta: Badan Penerbit IDAI; 2008. p.147-69.
Maisels M. Neonatal hyperbiliru binemia. In: Polin RA, Yo des MC, editors. Workbook in practical neonatology. 4th ed. Philadelphia: Saunders; 2007. p.53-70.
Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581-90.
Stokowsky LA. Fundamentals of phototherapy for neonatal jaundice. Adv Neonatal Care. 2006;6:302-12.
Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358:920-8.
Maisels MJ, Kring E. Rebound in serum bilirubin level following intensive phototheraphy. Arch Pediatr Adolesc Med. 2002;156:669-72.
Gomella TL. Hyperbilirubinemia indirect. In: Gomella TL, Cunningham MD, Eyal FG, editors. Neonatology: management, procedures, on-call problems, disease, and drugs. 5th ed. New York: McGraw-Hill; 2004. p.247-50.
Madan A, Macmahon JR, Stevenson DK. Neonatal hyperbilirubinemia. In: Taeusch HW, Ballard RA, Gleason CA, editors. Avery's disease of the newborn. 3th ed. Philadelphia: Elsevier Saunders; 2005. p.1226-53.
Suradi R, Situmeang EH, Tambunan T. The association of neonatal jaundice and breast-feeding. Paediatr Indones. 2001;41:69-75.
Djokomuljanto S, Quah BS, Surini Y, Noraida R, Ismail NZN, Hansen Tw, et al. Efficacy of phototherapy for neonatal jaundice is increased by the use of low-cost white reflecting curtains. Arch Dis Child Fetal Neonatal. 2006;91:439-42.
Maisels MJ. Phototherapy-traditional and nontraditional. J Perinatol. 2001;21:93-7.
Sarici SU, Alpay F, Unay B, Ozcan O, Gokcay E. Double versus single phototherapy in term newborns with significant hyperbilirubinemia. J Trop Pediatr. 2000;46:36-9.
Boonyarittipong P, Kriangburapa W, Booranavanich K. Effectiveness of double-surface intensive phototherapy versus single-surface intensive phototherapy for neonatal hyperbilirubinemia. J Med Assoc Thai. 2008;9l:50-5.
Silva I, Luco M, Tapia JL, Perez ME, Salinas JA, Flores J, Villaroel L. Single vs. double phototherapy in the treatment of full-term newborns with nonhemolytic hyperbilirubinemia. J Pediatr (Rio J). 2009;85:455-8.
Kang JH, Shankaran S. Double phototherapy with high irradiance compared with single phototherapy in neonates with hyperbilirubinemia. Am J Perinat. 1995;12:178-80.
Grunhagen DJ, De Boer MG, de Beaufort AJ, Walther FJ. Transepidermal water loss during halogen spotlight phototherapy in preterm infants. Pediatr Res. 2002;51:402-5.
Martin CR, Cloherty JP. Neonatal hyperbilirubinemia. In: Cloherty JP, Eichenwald EC, Stark AR, editors. Manual of neonatal care. 5th ed. Philadelphia: Lippincott, Williams & Wilkins; 2004. p. 183-221.
Bagchi A. Phototherapy. In: MacDonald MG, Ramasethu J, editors. Procedures in neonatology. 3rd ed. Philadelphia: Lippincott, William & Wilkins; 2002. p. 373-8.
Hansen TW: Phototherapy for neonatal jaundice-therapeutic effects on more than one level? Semin Perinatol. 2010;34:231-4.
Kaplan M, Kaplan E, Hammerman C, Algur N, Bromiker R, Schimmel MS, et al. Post-phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia. Arch Dis Child. 2006;91:31-4.
Yetman RJ, Parks DK, Huseby V, Mistry K, Garcia J. Rebound bilirubin levels in infants receiving phototherapy. J Pediatr. 1998;133:705-7.
Al-Saedi SA. Rebound hyperbilirubinemia in term infants after phototherapy. Saudi Med J. 2002;23:1394-7.
Bansal A, Jain S, Parmar VR, Chawla D. Bilirubin rebound after intensive phototherapy for neonatal jaundice. Indian Pediatr. 2010;47:607-9.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Accepted 2016-09-24
Published 2014-10-30
