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Scholars Journal of Applied Medical Sciences | Volume-8 | Issue-06
Study of Post Phototherapy Serum Bilirubin Rebound Levels in Near Term and Term Neonates
Singh H, Devpura K, Gothwal S, Nangliya V. L., Mathur P, Agarwal A
Published: June 24, 2020 | 167 212
DOI: 10.36347/sjams.2020.v08i06.022
Pages: 1502-1509
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Abstract
Neonatal hyperbilirubinemia is common in first week of life. Nearly 60% term & 80% preterm neonates develop jaundice in first week of life. American Academy of Pediatrics recommends that new born discharged within 48 hours should have a follow-up visit after 48 - 72 hours for any significant neonatal jaundice. These babies may develop jaundice which may be over looked or delay in recognition unless closely monitored. So it is necessary to measure serum total bilirubin in all jaundiced infants and ensure follow-up evaluation within 2 days of all infants discharged prior to 48 hours. Concern regarding early discharge is bilirubin induced neurological dysfunction (BIND) in healthy term infants even without hemolysis. No upper limit of serum bilirubin levels are defined for development of BIND in icteric new born but serum bilirubin level >20mg/dl is likely to be toxic and leads to significant brain damage. The pathogenesis of BIND is complex and related to the interplay between levels of unconjugated bilirubin, gestational maturity of infants and integrity of blood brain barrier. The concept of prediction of neonatal jaundice is an attractive option for clinical assessment of neonatal jaundice. Our study states that out of 150 neonates, 86 neonates (57.3%) no rebound hyperbilirubinemia seen, 47 (31.3%) developed insignificant rebound hyperbilirubinemia (i.e. serum bilirubin level increases after discontinuation of phototherapy but not crossed cut-off value of starting phototherapy), 10 (6.7%) developed significant bilirubin rebound (SBR) at 12 hours of discontinuation of phototherapy and 7 (4.7 %) developed SBR at 24 hours of discontinuation of phototherapy. So patient having higher serum bilirubin at the time of discontinuation of phototherapy along with risk factors developed more SBR. There are only few options for treatment of neonatal jaundice which are: Phototherapy, Exchange transfusion, Drugs like phenobarbitone, intravenous immunoglobulin.