From the Guidelines
Phototherapy sessions for neonatal jaundice should be continued until bilirubin levels fall below treatment thresholds, which is typically when the TSB has declined by 2 to 4 mg/dL below the hour-specific threshold at the initiation of phototherapy, as recommended by the most recent guidelines 1. The duration of phototherapy can vary depending on the severity of jaundice and the baby's response to treatment, but it is essential to continue therapy until bilirubin levels are within a safe range.
- Key factors to consider when determining the duration of phototherapy include:
- The initial bilirubin level and the rate of decline
- The baby's gestational age and weight
- The presence of any underlying medical conditions
- The effectiveness of the phototherapy in reducing bilirubin levels According to the latest technical report on phototherapy to prevent severe neonatal hyperbilirubinemia, the clinical impact of phototherapy should normally become evident within 4 hours of initiation, with an anticipated decrease in TSB concentrations of >2 mg/dL 1.
- During treatment, it is crucial to:
- Monitor bilirubin levels regularly, typically every 12-24 hours
- Maintain hydration and promote bilirubin excretion through stool
- Provide eye protection and a diaper to maximize skin exposure to the blue light
- Allow for brief breaks for feeding and parental bonding, as intermittent phototherapy is less effective than continuous treatment The decision to discontinue phototherapy should be individualized, taking into account the TSB level at which phototherapy was initiated, the cause of the hyperbilirubinemia, and the risk of rebound hyperbilirubinemia, as outlined in the guidelines 1.
From the Research
Phototherapy Session Duration for Neonatal Jaundice
- The duration of a phototherapy session for neonatal jaundice can vary depending on the specific treatment protocol and the individual patient's needs 2, 3.
- One study found that intermittent phototherapy (IPT) was applied as 2 cycles of 1 hour on and 2 hours off in a 6-hour session, with a median phototherapy time of 4 hours (2-4 hours) in the IPT group 2.
- Another study compared two groups of jaundiced newborns who received either 24 hours or 18 hours of continuous phototherapy, and found that the 18-hour course provided better hourly outcomes and reached its saturation point around the 18th hour 3.
- The duration of phototherapy can also depend on the level of bilirubin in the patient's blood, with higher levels requiring longer treatment times 4, 5.
- Intensive phototherapy has been shown to be effective in reducing the need for exchange transfusion and shortening the duration of phototherapy 5.
- Consensus guidelines for the management of neonatal hyperbilirubinemia have been developed, which include specific intervention thresholds for phototherapy and exchange transfusion 6.