Treatment of neonatal jaundice - more than phototherapy and exchange transfusions

Jaundice is the most common reason for doing blood tests and starting therapy in newborn infants. In some neonates serum bilirubin levels may become excessively high, and in rare instances this may lead to brain damage (kernicterus). In such cases it is important to start treatment quickly. Herein we will discuss various approaches through which serum bilirubin levels may be reduced, thus potentially preventing brain damage. This paper is based on relevant publications found through a Medline search, from which a selection was made based on the authors’ prior knowledge of and experience in the field. Case histories are used to illustrate the important points. Neonatal jaundice always has a foundation in normal physiology. However, the degree of jaundice may be accentuated by a number of pathological processes. These include hematomas and other occult hemorrhage, AB0- and Rhesus incompatibility, and increased enterohepatic circulation of bilirubin. In addition, genetic conditions such as galactosemia, hemolytic anemias, and Gilbert and Crigler-Najjar syndromes can significantly increase jaundice in newborn infants. Neonatal jaundice can be treated in several ways, including phototherapy, exchange transfusion, breast milk substitutes, and drugs (e.g. intravenous immune globulin and phenobarbital). By employing such therapies individually or in combination, it is possible to achieve rapid reductions of dangerously high bilirubin levels, and thus reduce the risk of sequelae. It is important to keep in mind that factors which may be unknown at the time of discharge from hospital or birthing unit can contribute to significant increases in total serum bilirubin levels after discharge. It is therefore important to evaluate an infant’s risk status prior to discharge. Written therapeutic guidelines for professionals are useful adjuncts in management, and oral and/or written orientation in terms and language which the parents can understand will help them as far as the post-discharge management. A written orientation in the form of a brief handout may also be a useful tool for educating parents prior to discharge.