Hyperbilirubinemia: Tool Predicts When It's Safe to Stop Therapy

Bridget M. Kuehn

February 16, 2017

A new tool could help physicians predict when it is safe to stop phototherapy for newborns with jaundice, according to a study published February 14 in Pediatrics. It may also allow some babies to leave the hospital sooner.

There are clear guidelines from the American Academy of Pediatrics regarding when physicians should start phototherapy in neonates with hyperbilirubinemia. However, recommendations are less clear on when stop this treatment, explain Pearl W. Chang, MD, from Seattle Children's Hospital in Washington, and colleagues.

This leaves physicians guessing about when it is safe to discontinue phototherapy. Stopping too early could lead to rebound hyperbilirubinemia and potential rehospitalization, the authors note. However, continuing treatment too long could unnecessarily extend the hospital stay and interfere with breastfeeding.

"The decision to discontinue phototherapy is based on balancing the risks and costs of prolonging treatment against the benefit of reducing the risk of rebound hyperbilirubinemia," Dr Chang and colleagues write.

Therefore, Dr Chang and colleagues developed an evidence-based tool for deciding when it is safe to stop phototherapy. To do this, they analyzed data from a cohort of 7048 neonates treated for hyperbilirubinemia who were born at 35 weeks of gestation or later at Kaiser Permanente's 17 hospitals in Northern California.

Using these data, the authors were able to identify three key predictors of rebound hyperbilirubinemia within the first 3 days of ending phototherapy. They found that babies born before 38 weeks' gestation and those with higher relative bilirubin scores at discontinuation were at increased risk for rebound, but those who were a few days older when the therapy started had a lower risk for a recurrence.

These results were consistent with those of other studies with smaller sample sizes, note Ian M. Paul, MD, a professor of pediatrics at the Department of Pediatrics and the Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, and M. Jeffrey Maisels, MB, BCh, DSc, a professor of pediatrics at Oakland University William Beaumont School of Medicine in Royal Oak, Michigan, in an accompanying editorial.

Next, Dr Chang and colleagues developed a simple mathematical formula that physicians can use to calculate the risk for recurrence using these three predictors. For example, an infant born at 37 weeks who starts phototherapy at 4 days after birth and reaches a total serum bilirubin 5 mg/dL below the American Academy of Pediatrics–recommended treatment threshold would receive a score of 17 and have a 2.8% estimated probability of a rebound if treatment were discontinued.

If the formula had been applied to infants in the study cohort, it would have been able to reduce inpatient phototherapy by a day in more than one third of the neonates with a risk for recurrence lower than 4%, according to the authors.

"Hospitalization is burdensome for families, and phototherapy can disrupt breastfeeding and infant bonding," the authors explain. There is also emerging evidence that phototherapy may be linked to the development of melanocytic nevi and infantile cancer, they write.

"Clinical implementation of this prediction rule via a Web-based calculator or integration into electronic medical records could help guide decisions [by clinicians and parents] about when to discontinue phototherapy," they continue.

Dr Paul and Dr Maisels explain that evidence-based electronic tools, such as the Neonatal Sepsis Calculator and Newborn Weight Tool, have been catching on in pediatrics.

"The formula used in the new prediction rule for rebound hyperbilirubinemia is simple and easy to use, and has similar potential to influence clinical care for those newborns receiving phototherapy," they conclude.

The authors of the study and the editorial have disclosed no relevant financial relationships.

Pediatrics. Published online February 14, 2017. Article abstract, Editorial extract

For more news, join us on Facebook and Twitter


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.