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Treatment

Recommendations – 7.1 How to manage hyperbilirubinaemia

Use the bilirubin level to determine the management of hyperbilirubinaemia in all babies (see
threshold table (Section 1.3) and treatment threshold graphs (Section 1.6)).
If the serum bilirubin level falls during continuous multiple phototherapy to a level
50 micromol/litre below the threshold for which exchange transfusion is indicated:
• step down to single phototherapy
Starting phototherapy
Use serum bilirubin measurement and the treatment thresholds in the threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6) when considering the use of
phototherapy.
In babies with a gestational age of 38 weeks or more whose bilirubin is in the ‘repeat
bilirubin measurement’ category in the threshold table (Section 1.3) repeat the bilirubin
measurement in 6–12 hours.
In babies with a gestational age of 38 weeks or more whose bilirubin is in the ‘consider
phototherapy’ category in the threshold table (Section 1.3) repeat the bilirubin measurement
in 6 hours regardless of whether or not phototherapy has subsequently been started.

Do not use phototherapy in babies whose bilirubin does not exceed the phototherapy
threshold levels in the threshold table (Section 1.3) and treatment threshold graphs
(Section 1.6).
During phototherapy
During phototherapy:
• repeat serum bilirubin measurement 4–6 hours after initiating phototherapy
• repeat serum bilirubin measurement every 6–12 hours when the serum bilirubin level is
stable or falling.
Stopping phototherapy
Stop phototherapy once serum bilirubin has fallen to a level at least 50 micromol/litre below
the phototherapy threshold (see threshold table (Section 1.3) and treatment threshold graphs
(Section 1.6)).
Check for rebound of significant hyperbilirubinaemia with a repeat serum bilirubin
measurement 12–18 hours after stopping phototherapy. Babies do not necessarily have to
remain in hospital for this to be done.

For recommendations on starting and stopping exchange transfusions, see Section 7.3. For
recommendations on the use of other treatments, including IVIG, see Section 7.4.

7.2 Phototherapy

As there is a large evidence base for phototherapy, the literature search was restricted to RCTs
and meta-analyses. Altogether, 472 records were identified by searches. These were screened
and 140 hard-copy articles were requested. Seventy-five studies included information about the
effect of phototherapy in combination with other treatments or were prophylaxis studies and
were excluded at this stage. From the remaining studies, 42 RCTs were included. No RCTs
dealing with sunlight or environmental light were found.
To evaluate the evidence more clearly, conventional phototherapy was compared initially with
no treatment, then with multiple phototherapy and finally with newer forms of phototherapy
including fibreoptic and light-emitting diode (LED) phototherapy. Various aspects of
phototherapy, such as choice of colour, whether given continuously or intermittently, and
positioning of the baby, were also examined. Meta-analysis was performed to calculate the
effectiveness of phototherapy using the program RevMan 5 (www.cc-ims.net/revman). Where
possible, a distinction was made between term and preterm babies and evidence was evaluated
accordingly.

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