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7 Treatment
Clinical questions
Phototherapy:
i) How effective is phototherapy?
ii) What is the best modality of giving phototherapy (clinical and cost-effectiveness)?
a) Conventional phototherapy (single, double or multiple phototherapy)
b) Sunlight
c) Fibreoptic phototherapy (biliblankets, bilibeds and other products)
iii) What are the criteria/indications for starting and stopping phototherapy in babies with
neonatal hyperbilirubinaemia?
iv) What is the correct procedure when administering phototherapy (with specific reference
to method of feeding/types of feed, incubator or bassinet care, the effect of intermittent
versus constant phototherapy on maternal–infant bonding, and parental anxiety)?
How to monitor a baby with jaundice?
i) What are the appropriate criteria for monitoring (timing, frequency) of babies with
jaundice who are at lower risk of developing neonatal hyperbilirubinaemia/kernicterus?
ii) What are the appropriate criteria for monitoring (timing, frequency) of babies diagnosed
with neonatal hyperbilirubinaemia who do not require immediate treatment?
When to discharge a baby treated for hyperbilirubinaemia? What follow-up is required?
i) What is the appropriate criterion for discharge of babies treated for neonatal
hyperbilirubinaemia?
ii) What is the appropriate timing/frequency of follow-up?
7.1 How to manage hyperbilirubinaemia
7.1.1 What are the indications for starting and stopping treatment in babies with
neonatal hyperbilirubinaemia?
Description of included studies
No studies were identified.
Review findings
No studies were identified.
Evidence summary
No evidence was identified.
GDG translation from evidence
The GDG recognised that was no reliable evidence to inform the choice of thresholds for
commencing therapy – including phototherapy and exchange transfusion – in babies with
jaundice. This was not surprising. The ultimate purpose of phototherapy is to prevent
kernicterus, and kernicterus is a rare event. Moreover, factors other than the absolute level of
total serum bilirubin are important additional risk factors for kernicterus – for example,
prematurity or co-existence of illnesses such as sepsis, perinatal asphyxia and acidosis. The
GDG recognised that for these reasons it was impossible to devise studies that would accurately
determine ‘correct’ thresholds for treatment. Nevertheless, therapeutic thresholds are important.
There is clear evidence that phototherapy is effective and can reduce the need for exchange
transfusion (see Section 7.2).
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