From the Guidelines
Phototherapy is the recommended treatment for a newborn with a bilirubin level of 14.1 mg/dL at 95 hours of life. The infant should be placed under special blue lights that emit wavelengths between 430-490 nm, which helps break down bilirubin in the skin. Treatment should continue until bilirubin levels decrease to a safe range, typically below 12-13 mg/dL, with follow-up measurements every 4-6 hours initially, then every 12-24 hours as levels improve, as suggested by 1.
The baby should be undressed except for a diaper to maximize skin exposure, with eyes covered by protective shields to prevent retinal damage. Adequate hydration must be maintained, with continued breastfeeding or formula feeding during therapy. This treatment is necessary because elevated bilirubin (hyperbilirubinemia) can lead to kernicterus, a form of brain damage, if left untreated. The specific bilirubin threshold requiring treatment varies based on the infant's age in hours, gestational age, and risk factors, but 14.1 mg/dL at 95 hours generally warrants intervention to prevent neurological complications, as indicated by 1 and 1.
Some key considerations for the treatment include:
- The use of total serum bilirubin (TSB) as the definitive diagnostic test to guide interventions 1
- The importance of identifying the cause of hyperbilirubinemia to provide additional care if necessary 1
- The need for close follow-up after phototherapy is discontinued to monitor for rebound hyperbilirubinemia 1
- The option to use home LED-based phototherapy devices for infants who meet specific criteria, as an alternative to hospital readmission 1
Overall, the goal of treatment is to reduce the risk of kernicterus and other neurological complications associated with hyperbilirubinemia, while minimizing the risks and side effects of phototherapy, as discussed in 1.
From the Research
Treatment for Newborn with Bilirubin Level of 14.1 mg/dL
- The recommended treatment for a newborn with a bilirubin level of 14.1 mg/dL at 95 hours of life is phototherapy, as it is a simple and effective way to reduce the bilirubin level 2.
- According to the American Academy of Pediatrics (AAP), phototherapy should be used only for newborns who exceed thresholds recommended by the current AAP hour-specific phototherapy nomograms 3.
- The AAP revised its clinical practice guideline in 2022 and reconfirmed its recommendation for universal neonatal hyperbilirubinemia screening in newborns 35 weeks' gestational age or greater 3.
- In some cases, phenobarbital in combination with phototherapy may be helpful to newborn infants with isoimmune hemolytic disease, as it results in a faster decline in total serum bilirubin, thus decreasing the need for blood exchange transfusion than phototherapy alone 4.
- It is essential to evaluate all newborns for risk factors for bilirubin-related neurotoxicity, and it is reasonable to obtain screening bilirubin levels in newborns with risk factors 3.
Risk Factors and Evaluation
- Newborns who are premature or have hemolytic diseases are at higher risk of kernicterus 3.
- The evaluation of patients with jaundice starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver 5.
- Any infant with high serum bilirubin or a rapidly rising bilirubin level needs to be treated urgently to avoid neurotoxicity 2.