High-intensity phototherapy for the treatment of severe nonhaemolytic neonatal hyperbilirubinemia.
OBJECTIVE
To describe the clinical approach to term and near-term newborn infants with severe hyperbilirubinaemia and to analyse the effect of high-intensity phototherapy on total serum bilirubin (TSB) levels.


METHODS
We analysed a cohort of 116 newborn infants with severe nonhaemolytic hyperbilirubinaemia (TSB ≥20 mg/dL/342 μmol/L). All patients were treated with high-intensity phototherapy. The main outcomes were reduction in TSB levels in the first 24 h of phototherapy, incidence of exchange transfusion, pathological brainstem auditory evoked responses and pathological findings on neurological examination at discharge.


RESULTS
The mean birth weight and gestational age were 3161±466 g and 37.8±1.6 weeks. Mean initial TSB concentration was 22.4±2.4 mg/dL. Per cent decreases in TSB after 2, 4, 6, 12, 18 and 24 h of phototherapy were 9.4%, 16%, 23%, 40%, 44% and 50%, respectively. No infant was treated with exchange transfusion. Brainstem evoked response audiometry (BAER) was performed in 100% of the patients, and in three of them, this examination was altered. However, when repeated 3 months later, these BAER examinations were normal. Neurological examination was normal in all patients.


CONCLUSIONS
High-intensity phototherapy significantly reduces TSB in nonhaemolytic severe hyperbilirubinaemia and decreases the need for exchange transfusion.
Department of Neonatology, Instituto Fernandes Figueira/Fiocruz, Flamengo, Rio de Janeiro, Brazil.
Manoel
M
de Carvalho
Christieny Chaipp
CC
Mochdece
Cynthia Amaral Moura
CA
Sá
Maria Elisabeth Lopes
ME
Moreira
D005078:Exchange Transfusion, Whole Blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D051556:Hyperbilirubinemia, Neonatal / Q000097:blood / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome