Title: Rebound Hyperbilirubinemia in Neonates after Phototherapy and Factors Affecting It
Authors: Dr Subhash K Valinjkar, Dr Nita.R Sutay, Dr Bharti Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.113
Abstract
Aims and Objectives:
1. To determine the incidence of significant bilirubin rebound 24 hours after stopping phototherapy in neonates with hyperbilirubinemia.
2. To correlate the significant bilirubin rebound with prematurity, gestational age, birth weight and mode of feeding.
Study Design: This was a prospective cohort study done in the department of paediatrics a tertiary care hospital in a metropolitan city.
Materials and Methods: The study was approved by the Institutional ethical committee. The neonates in neonatal intensive care units and neonatal wards who were clinically icteric were enrolled in the study as per the given criteria. It was a prospective, cohort study conducted on neonates having hyperbilirubinemia requiring phototherapy or neonates requiring readmission for phototherapy.
Results: All 300 babies had icterus. Out of the studied cases 148 (49.3%) were females and 152 (50.7%) were males with female: male ratio of 1:1.02. The mean birth weight was 2.43 +/- 1.12 kg and mean gestational age was 36.5+/- 5.1 weeks. Most of the babies had birth weight more than 2.5 kg (64%) followed by birth weight between 1.5-2.5 kg (25%) and 1-1.5 kg (11%). There was no neonate with a birth weight less than 1 kg. Majority of the neonates enrolled in this study were full term (67.4%) followed by gestational age less than 35 weeks (18.3%) and between 35-37 weeks (14.3%). 249 babies were receiving direct breast feeding while 39 babies were kept till by mouth and 12 babies were being fed through orogastric tube. All babies received either single surface phototherapy (56%), double surface phototherapy (38%) or intensive phototherapy (6%) depending upon serum bilirubin levels. The mean bilirubin levels at termination of phototherapy were 13.4 +/- 1.5mg/dl and 11.5+/-4.6 mg/dl in term and preterm neonates respectively. While the mean rebound bilirubin levels after 24 hours of terminating phototherapy were 12.1+/- 2.08 mg/dl and 11.0+/-4.1 mg/dl in term and preterm neonates respectively. The difference in both bilirubin levels were 1.6 +/- 0.68 mg/dl in term and 1.7+/- 2.6 mg/dl in preterm newborns. Incidence of rebound was found to be 11%. The most common cause of hyperbilirubinemia was found to be physiological jaundice (64.7%) followed by prematurity (27%), polycythemia (3.7%) and sepsis (3.3%). 4 cases (1.3%) were found to be having pathological jaundice secondary to ABO incompatibility. Rebound hyperbilirubinemia was seen in 14 preterm neonates (4.6%), 5 neonates with physiological jaundice (1.7%), 6 neonates with polycythemia, ABO incompatibility and sepsis each (2% each). Neonates with prematurity, physiological jaundice, polycythemia, very low birth weight, gestational age less than 35 weeks, those kept till by mouth, those who received double surface or intensive phototherapy and sepsis were found to be statistically significantly associated with significant bilirubin rebound. ABO incompatibility and low birth weight (1.5-2.5 kg ) were not found to be statistically significantly associated with significant bilirubin rebound. Gestational age of 37 weeks or more and direct breast feeding were Factors associated with statistically significant decreased risk of developing rebound hyperbilirubinemia.
Conclusion: Our study focused on the study of significant hyperbilirubinemia after termination of phototherapy and factors affecting it. We found that rebound of bilirubin levels was of significant importance in preterm neonates with gestational age less than 35 weeks, in very low birth weight babies and neonates with polycythemia and sepsis. Babies who have been treated with intensive phototherapy were found to be prone foe developing rebound hyperbilirubinemia while breast fed babies and neonates who had physiological jaundice were found to have less likelihood of developing significant bilirubin rebound.
Keyword: Neonatal hyperbilirubinemia, significant bilirubin rebound, Risk factors, phototherapy.
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Dr Bharti Sharma, MD Paediatrics
Senior Resident, FNB Peadiatric Cardiology
Grant Medial College Mumbai