Page 15 - 16Neonatal Jaundice_compressed

Guidance summary

ID Recommendations See Chapter/Section
Stopping phototherapy
28 Stop phototherapy once serum bilirubin has fallen to a level at least 7.1.2
50 micromol/litre below the phototherapy threshold (see threshold table
(Section 1.3) and treatment threshold graphs (Section 1.6)).
29 Check for rebound of significant hyperbilirubinaemia with a repeat serum 7.1.2
bilirubin measurement 12–18 hours after stopping phototherapy. Babies
do not necessarily have to remain in hospital for this to be done.

Type of phototherapy to use
30 Do not use sunlight as treatment for hyperbilirubinaemia. 7.2.1

Single phototherapy treatment for term babies
31 Use conventional ‘blue light’ phototherapy as treatment for significant 7.2.1
hyperbilirubinaemia in babies with a gestational age of 37 weeks or more
unless:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre
per hour)
• the serum bilirubin is at a level that is within 50 micromol/litre below
the threshold for which exchange transfusion is indicated after 72 hours
(see the threshold table (Section 1.3) and treatment threshold graphs
(Section 1.6)).
32 Do not use fibreoptic phototherapy as first-line treatment for 7.2.1
hyperbilirubinaemia for babies with a gestational age of 37 weeks or
more.
Single phototherapy treatment in preterm babies
33 Use either fibreoptic phototherapy or conventional ‘blue light’ 7.2.1
phototherapy as treatment for significant hyperbilirubinaemia in babies
less than 37 weeks unless:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre
per hour)
• the serum bilirubin is at a level that is within 50 micromol/litre below
the threshold for which exchange transfusion is indicated after 72 hours
(see treatment threshold table (Section 1.3) and treatment threshold
graphs (Section 1.6)).
Continuous multiple phototherapy treatment for term and pre term babies
34 Initiate continuous multiple phototherapy to treat all babies if any of the 7.2.1
following apply:
• the serum bilirubin level is rising rapidly (more than 8.5 micromol/litre
per hour)
• the serum bilirubin is at a level within 50 micromol/litre below the
threshold for which exchange transfusion is indicated after 72 hours
(see threshold table (Section 1.3) and treatment threshold graphs
(Section 1.6)).
• the bilirubin level fails to respond to single phototherapy (that is, the
level of serum bilirubin continues to rise, or does not fall, within
6 hours of starting single phototherapy)
35 If the serum bilirubin level falls during continuous multiple phototherapy 7.1.1
to a level 50 micromol/litre below the threshold for which exchange
transfusion is indicated step down to single phototherapy.

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