Post-phototherapy neonatal bilirubin rebound: A potential cause of significant hyperbilirubinaemia

Michael Kaplan ^1*, Eytan Kaplan ², Cathy Hammerman ¹, Nurit Algur ¹, Ruben Bromiker ¹, Michael S Schimmel ¹ and Arthur I Eidelman ¹

¹ Shaare Zedek Medical Center, Israel
² Be'er Sheva, Israel

^* To whom correspondence should be addressed. E-mail: kaplan{at}cc.huji.ac.il.

Accepted 19 September 2005

Abstract

Objective:To determine the incidence of post- phototherapy neonatal plasma total bilirubin (PTB) rebound.

Methods:A prospective clinical survey was performed on 226 term and near-term neonates treated with phototherapy in the well baby nursery of the Shaare Zedek Medical Center from January 2001 to September 2002. Neonates were tested for PTB 24 ± 12 hr after discontinuation of phototherapy, with additional testing as clinically indicated. The main outcome measure, significant bilirubin rebound, was defined as a post-phototherapy PTB > 256 µmol/L. Phototherapy was not reinstituted in all cases of rebound, but rather according to clinical indications.

Results:30 (13.3%) neonates developed significant rebound (mean (SD) PTB 287 ± 27 µmol/L, upper range 351 µmol/L). 22 of these (73%) were retreated with phototherapy at mean PTB 296 ± 29 µmol/L. Multiple logistic regression analysis demonstrated significant risk for aetiologic risk factors including positive direct Coombs' test (Odds Ratio 2.44, 95% Confidence Interval 1.25-4.74, p=0.028) and gestational age <37 weeks (Odds ratio 3.21, 95% Confidence Interval 1.29-7.96, p=0.036). A greater number of neonates rebounded among those in whom phototherapy was commenced < 72 hours (26/152, 17%) compared with > 72 hours (4/74, 5.4%), Odds Ratio 3.61, 95% Confidence Interval 1.21 - 10.77.

Conclusion:Post-phototherapy neonatal bilirubin rebound to clinically significant levels may occur, especially in cases of prematurity, direct Coombs' test positivity, and those treated < 72 hours. These risk factors should be taken into account when planning post- phototherapy follow up.

Keywords: bilirubin, coombs' positivity, phototherapy, prematurity, rebound

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