Evaluation of elevated bilirubin recognized by yellowing of the skin and whites of the eyes in newborn infants, and application of appropriate treatment, primarily phototherapy (blue light).
Indication
- Early jaundice appearing in the first 24 hours after birth (always considered pathological)
- Infants whose total serum bilirubin exceeds the phototherapy threshold on the age-in-hours nomogram (Bhutani)
- Hemolytic causes such as mother-infant blood group incompatibility (Rh, ABO) or G6PD deficiency
- Need for treatment at lower bilirubin thresholds in premature infants
- Prolonged jaundice due to breast milk jaundice or inadequate feeding
- High-risk situations such as cephalohematoma, multiple pregnancy, or significant jaundice history in a sibling
- Very high bilirubin levels even in the absence of acute bilirubin encephalopathy (kernicterus) findings
Preparation
- Mother-infant blood group, Coombs test, and if needed complete blood count and reticulocyte count are performed after birth
- Total and direct bilirubin levels are obtained together with calculation of the infant's age in hours
- Frequency of breastfeeding and urine-stool output are reviewed; percentage of weight loss is calculated
- The family is informed about the use of the phototherapy device and the importance of continuing breastfeeding
How it's performed
- The infant is placed under the phototherapy device with eyes covered using a special mask and the genital area protected
- Blue light at a specific wavelength (approximately 460-490 nm) converts bilirubin into a water-soluble form
- Body temperature, fluid balance, and urine output are closely monitored during treatment
- Breastfeeding is continued as uninterruptedly as possible; supplementary feeding is planned when needed
- Bilirubin levels are remeasured every 4-8 hours and tracked on the nomogram
- Exchange transfusion is considered for infants who do not respond to phototherapy, show signs of hemolysis, or have critically high values
Post-procedure
- Bilirubin is rechecked within 12-24 hours after phototherapy to monitor for rebound (rise after stopping)
- Feeding, weight gain, and urine-stool output are followed regularly
- A follow-up visit is recommended within the first 1-2 weeks after discharge to evaluate skin color and general condition
- If hemolytic disease is present, a complete blood count may be requested 4-6 weeks later to assess for anemia
- Hearing screening and neurodevelopmental follow-up are planned when indicated
Risks
- Transient skin rash, mild diarrhea, or mild fluid loss during phototherapy
- Drop or rise in body temperature (prevented with close monitoring)
- Rare risks of electrolyte imbalance or infection when exchange transfusion is required
- If treatment is delayed, kernicterus (acute/chronic bilirubin encephalopathy) due to bilirubin crossing into the brain — quite rare with modern follow-up
FAQ
Is my baby's jaundice dangerous?
Most newborn jaundice is physiological and resolves on its own. However, jaundice that begins within the first 24 hours, rises rapidly, or lasts longer than 2 weeks must be evaluated.
Can I breastfeed during phototherapy?
Yes, breastfeeding is continued and often increased. Frequent feeding helps eliminate bilirubin. Outside of feeding breaks, the baby is kept under the light.
Can sunlight replace phototherapy?
No. Sunlight is not at the appropriate wavelength or intensity, and it carries risks of sunburn and hypothermia. Sunlight is not used as a substitute for medical phototherapy.
Is exchange transfusion performed on every baby?
No. Exchange transfusion is performed only on a small number of infants who do not respond to phototherapy, show signs of acute bilirubin encephalopathy, or exceed the exchange transfusion threshold on the nomogram.
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