From the Guidelines
Phototherapy is the primary treatment for hyperbilirubinemia, especially in neonates, as it reduces the risk of bilirubin neurotoxicity and the need for exchange transfusions 1. When considering treatment for hyperbilirubinemia, it's crucial to differentiate between unconjugated and conjugated hyperbilirubinemia, as this distinction guides the therapeutic approach.
- For unconjugated hyperbilirubinemia, medications like phenobarbital may be used to induce liver enzymes, but this is not the first line of treatment.
- For conjugated hyperbilirubinemia, ursodeoxycholic acid (ursodiol) may be considered if there's an obstruction of bile flow. However, the most recent and highest quality evidence supports the use of phototherapy as the primary intervention for hyperbilirubinemia, particularly in neonates at high risk 1. Other treatments, such as tin-mesoporphyrin, have been studied for their potential in preventing or treating hyperbilirubinemia but are not currently approved for use 1. In clinical practice, the decision to treat hyperbilirubinemia and the choice of treatment should be guided by the severity of the condition, the presence of risk factors for bilirubin neurotoxicity, and the underlying cause of the hyperbilirubinemia, with phototherapy being the cornerstone of treatment for severe cases, as evidenced by recent studies 1.
From the Research
Medications Used to Treat Hyperbilirubinemia
- Phenobarbital is used to treat hyperbilirubinemia, as seen in studies 2, 3, 4
- The use of phenobarbital in combination with phototherapy has been shown to enhance the decline of total serum bilirubin and may decrease the need for blood exchange transfusion in newborns with isoimmune hemolytic disease 4
- Phenobarbital treatment is recommended in patients with congenital hemolytic anemia in whom hyperbilirubinemia is not improved by splenectomy or in whom splenectomy is not indicated 3
Alternative Treatments
- Phototherapy is a primary treatment modality used to keep the maximal total serum bilirubin below pathologic levels 5
- Intensive phototherapy can be as useful as exchange transfusion in severe hemolytic disease of the newborn 2
- Corticosteroids and ursodeoxycholic acid (UDCA) are used to treat primary biliary cirrhosis-related autoimmune hemolytic anemia, which can cause hyperbilirubinemia 6