From the Guidelines
Bilirubin levels should be checked every 2-3 hours if the total serum bilirubin (TSB) is ≥ 25 mg/dL, every 3-4 hours if TSB is 20-25 mg/dL, and every 4-6 hours if TSB is < 20 mg/dL, during phototherapy, as recommended by the American Academy of Pediatrics 1. The frequency of checking bilirubin levels is crucial in managing hyperbilirubinemia in newborns, especially those receiving phototherapy.
- The initial frequency of bilirubin monitoring depends on the severity of hyperbilirubinemia, with more frequent checks for higher bilirubin levels.
- For example, if the TSB is ≥ 25 mg/dL, bilirubin levels should be checked every 2-3 hours, while levels < 20 mg/dL can be checked every 4-6 hours 1.
- Phototherapy sessions are typically continuous, but may be interrupted for feeding and parent-infant bonding, with the goal of maintaining maximal body irradiance for 20-24 hours per day during hyperbilirubinemic crises 1.
- The distribution of phototherapy sessions should be tailored to the individual patient's needs, with more intensive therapy for those with higher bilirubin levels or other risk factors.
- Treatment can be discontinued when bilirubin levels fall below safe thresholds, and a follow-up bilirubin level should be checked within 12-24 hours to ensure there is no significant rebound 1.
- It is essential to balance the need for frequent bilirubin monitoring with the need to minimize blood draws in neonates, and to prioritize the prevention of kernicterus and neurological damage.
From the Research
Bilirubin Monitoring in Phototherapy
- The frequency of bilirubin monitoring in phototherapy is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that daily evaluation of transcutaneous bilirubin measurement can provide additional information on the rise of serum bilirubin level, and can help to distinguish physiological from nonphysiological hyperbilirubinemia 5.
- The use of transcutaneous measurements of bilirubin is also suggested as a screening device to detect clinically significant jaundice and decrease the need for serum bilirubin determinations 6.
Sessions Distribution
- The distribution of phototherapy sessions is not clearly outlined in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that phototherapy can be an effective treatment for neonatal jaundice, and that its therapeutic effect is correlated with its irradiance 2.
- The use of double-LED phototherapy as a bridging treatment to exchange transfusion is also suggested as a potential treatment strategy for infants with severe hyperbilirubinemia 2.
- The guidelines for the management of hyperbilirubinemia in neonates, including the use of phototherapy and exchange transfusion, are discussed in 4, but the specific distribution of sessions is not provided.