From the Guidelines
Phototherapy is the primary treatment for hyperbilirubinemia, particularly in neonates, as it has been shown to reduce the risk of bilirubin neurotoxicity and the need for exchange transfusions 1.
Treatment Overview
The goal of treatment is to reduce bilirubin levels and prevent kernicterus and neurological complications.
- Phototherapy is the first-line treatment for severe hyperbilirubinemia, with a wavelength range of 460-490 nm and an irradiance of 25-35 mW/cm2/nm 1.
- In addition to phototherapy, exchange transfusion may be necessary for neonates with severe hyperbilirubinemia not responding to phototherapy.
- Treating the underlying cause of hyperbilirubinemia is essential, which may include stopping hepatotoxic medications or addressing liver disease.
Medications
While phototherapy is the primary treatment, medications such as phenobarbital may be used as adjunct therapy.
- Phenobarbital works by increasing the activity of glucuronyl transferase, which enhances bilirubin conjugation and excretion 2.
- However, the use of phenobarbital is not supported by the most recent evidence, and phototherapy remains the preferred treatment 1.
Special Considerations
- Crigler-Najjar syndrome type I requires initial exchange transfusions and long-term utilization of phototherapy to prevent kernicterus 3.
- Liver transplantation may be necessary for some cases of hyperbilirubinemia, particularly those with underlying liver disease 3.
Monitoring and Hydration
- Monitoring is essential during treatment to prevent kernicterus and neurological complications.
- Hydration is also important during treatment to help with bilirubin excretion. In summary, phototherapy is the primary treatment for hyperbilirubinemia, and treatment should be initiated promptly when bilirubin levels exceed age-specific thresholds to prevent kernicterus and neurological complications 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Medications for Hyperbilirubinemia
The following medications have been studied for the treatment of hyperbilirubinemia:
- Metalloporphyrins, such as Sn-mesoporphyrin (SnMP) and tin-mesoporphyrin, which inhibit bilirubin production 4, 5, 6, 7
- Clofibrate, which stimulates hepatic clearance of bilirubin 4
- Bile salts, which may help interrupt the enterohepatic circulation of bilirubin 4
- Laxatives, which may help reduce the absorption of bilirubin from the gastrointestinal tract 4
- Bilirubin oxidase, which converts bilirubin to a water-soluble isomer 4
Specific Medications and Their Uses
- Sn-mesoporphyrin (SnMP) has been shown to be effective in preventing and treating hyperbilirubinemia in G6PD-deficient neonates 5 and in infants with Rh hemolytic disease 6
- Tin-mesoporphyrin has been used to treat refractory hyperbilirubinemia due to Rh incompatibility 6
- A single dose of Sn-mesoporphyrin (6 μmol/kg body weight) has been shown to be a promising treatment modality for controlling hyperbilirubinemia in healthy term or near-term infants 7
Prevention and Treatment Strategies
- Preventive measures include detecting neonates at risk for developing hyperbilirubinemia through simple tests such as blood type, Rh, Coombs' test, and glucose-6-phosphate dehydrogenase 7
- Treatment modalities include phototherapy, exchange transfusion, and binding to immunoglobulin 7, 8
- New technologies may allow for the measurement of unbound bilirubin, which may be a more effective indicator of bilirubin neurotoxicity than total serum bilirubin 8