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.
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Accepted 2016-09-24
Published 2014-10-30
