DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20173993

Post phototherapy bilirubin rebound: incidence and risk factors

Richa Soni, Shayam L. Kaushik, Rajni Kaushik, Parveen Bhardwaj, S. Mohabey

Abstract


Background: Rebound hyperbilirubinemia may occur after cessation of phototherapy in new-borns in certain high-risk situations. However, data regarding the phenomenon of bilirubin rebound is lacking from India. Aim was to study the incidence and associated risk factors of post phototherapy rebound hyperbilirubinemia.

Methods: The study subjects included all neonates (gestation >34 weeks) admitted to newborn unit who required phototherapy for hyperbilirubinemia. Unit protocol based on American academy of pediatrics (AAP) guidelines were used to start and stop phototherapy. Rebound bilirubin was measured 24±6 hours after stopping phototherapy. Significant bilirubin rebound (SBR) was defined as post phototherapy bilirubin level needing reinstitution of phototherapy. The risk factors associated with significant rebound were studied.

Results: Out of total 509 neonates who received phototherapy due to hyperbilirubinemia, 63 (12%) had significant bilirubin rebound requiring reinstitution of phototherapy. There was significant risk for rebound in neonates who had prematurity (p <0.01), ABO (<0.001) and Rh incompatibility (p<0.005) with mother, G6PD deficiency (p < 0.001) and onset of hyperbilirubinemia less than 72 hours of postnatal age (p< 0.001). However, neonates with extravasations of blood, polycythaemia, sepsis, other causes of haemolysis and idiopathic group did not have significant risk of developing rebound.

Conclusions: Post phototherapy bilirubin estimation and follow up should be ensured in high-risk neonates.


Keywords


Hyperbilirubinemia, Phototherapy, Rebound

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References


Watchko JF Neonatal Indirect Hyperbilirubinemia and Kernicterus. In: Gleason CA, Devaskar S, eds. Avery's Diseases of the Newborn, 9th ed. Elsevier Inc; 2012;1123-1142.

Ambalavanan N, Waldemar A. Carlo Jaundice and Hyperbilirubinemia in the Newborn. In: Kliegman RM, Stanton B, Geme J, Schor N, Behrman RE, eds. Nelson Textbook of Pediatrics, 19th ed. Saunders, an imprint of Elsevier Inc; 2011;603-612.

Lazar L, Litwin A, Merlob P. Phototherapy for neonatal non-hemolytic hyperbilirubinemia. Analysis of rebound and indications for discontinuing therapy. Clin Pediatr. 1993;32(5):264-7.

Yetman RJ, Parks DK, Huseby V, Mistry K, Garcia J. Rebound bilirubin levels in infants receiving phototherapy. J Pediatr. 1998;133(5):705-7.

Maisels MJ, Kring E. Rebound in serum bilirubin level following intensive phototherapy. Arch Pediatr Adolesc Med. 2002;156(7):669-72.

Del Vecchio MT, Benstock MA, Sundel ER. Bilirubin rebound. J Pediatr. 1999;135(4):531-2.

Al-Saedi SA. Rebound hyperbilirubinemia in term infants after phototherapy. Saudi Med J. 2002;23(11):1394-7.

Erdeve O, Tiras U, Dallar Y. Rebound bilirubin measurement is not required for hyperbilirubinemia regardless of the background attributes of new-borns. Trop Pediatric. 2004;50(5):309.

Anuradha B, Suksham J, Veena RP, Deepak C. Bilirubin rebound after intensive phototherapy for neonatal jaundice. Indian Pediatr. 2010;47:607-9.

American Academy of Pediatrics. Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the new-born infant 35 or more weeks of gestation. Pediatrics. 2004;114:297-316.

Kaplan M, Kaplan E, Hammerman C, Algur N, Bromiker R, Schimmel MS, et al. Post phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia. Arch Dis Child. 2006;91:31-4.

Jodeiry B, Fakhraee SH, Kazemian M, Afjeiee SA, Javaherizadeh H. Rebound hyperbilirubinemia in neonates admitted to Mofid Children’s Hospital, Tehran, Iran. South African J Child Health. 2013;7(1):22-4.

Stanley IP, Chung M, Kulig j, O'Brien R, Sege R, Glicken S, et al. An Evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004;114(1):e130-53.